Dental Check-In

Name(Required)
MM slash DD slash YYYY
Has your pet experienced any changes in urination or defecation?(Required)
Has your pet experienced any changes in behavior?(Required)
I the undersigned owner or agent of the owner of the pet identified above, certify that I am eighteen years of age or older and authorize Sharp Pet Hospital to perform a Comprehensive Oral Health Assessment with Dental Scaling and Polishing. understand that during the performance of the above dental procedure unforeseen conditions may be revealed that require additional treatment. These treatments may include removal of teeth, gum tissue and/or jawbone or portions there of. I understand that no healthy teeth, gum tissue, or bone will be willfully removed other than that which is required to insure the health of the surrounding teeth/tissue/bone or to further the health and pain relief of the pet. Therefore, I consent to and authorize the performance of such dental procedures and/or operations as necessary in the veterinarian's professional judgment. I also authorize the use of appropriate anesthetics and other medications. have been advised as to the nature of the dental procedure and/or operation and the risks involved. I understand that some risks always exist with anesthesia and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. I realize that results cannot be guaranteed. I realize and understand that if the removal of teeth, tissue or bone is required, or if further dental procedures or operations are required, additional expenses will be incurred.
Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, select the following answer:(Required)
While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I agree to financial responsibility for the remaining fees and will provide payment via cash or credit card at the time my pet is discharged from the hospital.
(Required)