Dental Procedure Authorization Form

I hereby authorize performance of the dental procedure listed above, including placement of an IV catheter and pre-anesthetic bloodwork. I understand this procedure requires to be placed under anesthesia and that all procedures involving general anesthesia carry a very small risk of complications including death.If becomes stressed during the blood draw or catheter placement, I authorize the Doctors to administer sedation to allow catheter placement and a blood draw prior to the procedure.

(If any additional procedures are needed, the veterinarian will attempt to contact you at the number you provide below.) If I cannot be reached at the number provided, I authorize the veterinarians to perform additional procedures they deem medically necessary for ’s well being. I understand added procedures will bean additional expense. I assume financial responsibility for all services rendered and agree that payment is due on the date of the procedure. Pre-anesthetic bloodwork may be run up to one week in advance of a procedure, or at the Doctors’ discretion.

Every two seconds a family pet is lost. Many are never reunited with their families because they cannot be identified. Because of these statistics, we suggest microchips whenever a pet is sedated. HomeAgainchips are known nationwide and have a 24-hour hot-line to match chip numbers with owner’s contact information. The cost of microchip implantation is $61.50

If parasites are found, we will apply the appropriate topical treatment at the single-dose price.