Owner’s Name *

First

Last

Pet’s Name

Layout

Phone numbers (1st) *

Phone numbers (2nd)

Email (optional)

Unless otherwise specified by a doctor, please call between 1-3 p.m. to check on your pet and his/her pickup time. We may want to schedule a brief appointment at pick up to discuss your pet’s dentistry.

Does your pet have a microchip? *

Yes
No

What is the microchip number? *

Has your pet eaten this morning? *

Yes
No

If yes, Please explain *

After your pet’s procedure, we would like to offer your pet a small meal. What can we feed your pet? *

Has your pet had morning medications? *

Yes
No

list if any *

Does your pet need a prescription refill today? *

Yes
No

Please specify *

Have you received an estimate for services? *

Yes
No

If yes, Please explain

If not, a staff member must be able to reach you with an estimated cost prior to treatment.

Our goal is to preserve all teeth and extract only those that are hopelessly diseased. During the oral examination and cleaning we may discover additional problems. Please refer to the questions below. In the event we are unable to contact you, we will perform only those procedures you have marked below.

Permission is granted to: *

Give anesthesia to perform dental exam, dental x-rays and cleaning.
Extract any diseased teeth
I authorize additional procedures the doctor feels is necessary and will pay the additional charges.
I authorize necessary procedures / expense

If medication is sent home, which of the following would you prefer administering? *

What type of dental care are you willing? *

Additional Procedure being done today *

Our greatest concern is the well being of your pet. Prior to anesthesia, we will perform a pre-surgical evaluation. However, many conditions, including disorders of the liver, kidneys, or electrolyte function, are not detected unless blood testing is performed. Our laboratory will perform these tests and we will evaluate the results prior to anesthesia and/or surgery.

In the event of an emergency, it is expressly understood that the hospital and authorized personnel shall have authority and permission to prescribe for, treat and/or perform surgery upon the described animal. Should your pet require care from a Veterinary Specialist or Emergency Hospital, we will provide them with your current address and phone number.

To prevent the spread of infectious diseases and parasites, hospitalized animals must be current on all vaccines and be free of external and internal parasites. I hereby authorize Best Friends Animal Hospital to provide the vaccines and parasite control when needed.

Signature *

Date *

Online Form

Dentistry Consent Form

Welcome to West Main Animal Hospital

Thank you for selecting our veterinary healthcare team!

Ready to Visit?

URGENT cARE

Have A Question?

Location

Contact Information

Hours