Dental Consent Form

FOR THE PROTECTION OF YOUR PET AS WELL AS THE OTHER HOSPITAL GUESTS, YOU MAY INCUR AN ADDITIONAL FEE FOR TREATMENT IF YOUR PET IS FOUND TO HAVE EXTERNAL PARASITES INCLUDING BUT NOT LIMITED TO ticks, fleas, lice, mites, ect. 

CARDIOPULMINARY RESUSCITATION

PRE-OPERATIVE BLOOD TESTING

Like you, our greatest concern is the wellbeing of your pet. An assessment of your pet’s health will be done prior to anesthesia. However, many conditions including disorders of the liver, kidneys, or blood are not detected unless blood testing is performed. 

Surgical safety blood testing is MANDATORY on pets 5-8 years old the additional cost will be $101.05

Geriatric blood testing is MANDATORY on pets 8 years or older, the additional cost will be $214.74

PLEASE READ AND SIGN THIS SIDE BEFORE FILLING OUT THE REST

EXPLANATION OF DENTAL COSTS

Please read thoroughly. If you have any questions, please do not hesitate to ask us to explain it. 

DENTAL PRICES AND DESCRIPTIONS:
Dental prices include anesthesia, intravenous catheter, monitoring, cleaning, polishing and
hospitalization. 

Dental Cleaning-1…..………………(1-30 minute cleaning)……..….…..….$275.00
Dental Cleaning -2…..………………(30-45 minute cleaning)……..….…….$315.00
Dental Cleaning -3…..….……………(46+ minute cleaning)………..……….$365.00

DESCRIPTION OF COSTS NOT INCLUDED IN ROUTINE DENTAL PROPHY FEES:

Extraction costs vary depending on the technical difficulty and the amount of time required. This can be from as little as $7.50 for loose teeth that are extracted easily to as much as $200 for a multiple rooted tooth where gum and bone surgery are needed.

Antibiotic injection…………………………………………………………………………………$20.00
Analgesic/Pain injection……………………………………………………………………………$25.00
Dental X-Ray…………………………………………………………………………………………$17.00

Prescriptions to be sent home may vary in price due to condition and weight of pet; Therefore, those prices are not listed.

Read and initial before processing with care

As the legal owner or agent, I give my consent for Companion Animal Clinic and its staff to administer medical and/or surgical treatment for my pet. I understand that unforeseen conditions may occur which could require additional of different treatments than initially expected.

I acknowledge that there are risks of injury or death in the administration of anesthetics. I do not hold Companion Animal Clinic or its staff liable for the problems that might occur, provided reasonable care and precautions are followed.

I understand that additional charges may occur if I fail to pick up my pet at the agreed upon time. If a pet is left for more than fifteen (15) days, it will be considered abandoned.

As owner or agent, I assume financial responsibility for all charges incurred and recognize that the actual charges may be more or less than estimated, depending on the treatments rendered. 

OUR PAYMENT POLICY

PAYMENT IS DUE AT TIME OF SERVICE: WE ACCEPT CASH, MC, VISA, DISCOVER, AND CARE CREDIT. IF YOU ARE EXPERIENCING FINANCIAL DIFFICULTY, PLEASE LET US KNOW AND WE WILL BE HAPPY TO RESCHEDULE YOUR APPOINTMENT FOR A MORE CONVENIENT TIME