Dental Consent Form

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I, being the owner or authorized agent, hereby authorize Pacific Cat Clinic, Dr. Helen Bell or other authorized veterinarian to perform and provide all necessary hospital services, drugs and medical supplies as are reasonably required in the treatment of my cat. I understand that there is some risk involved during medical, surgical and anesthetic procedures. I agree to be responsible to pay all of the reasonable and appropriate charges for these services at the time of discharge.

 

Today

If my cat develops unexpected complications and other emergency procedures are necessary above and beyond the initial procedure discussed, I understand that Pacific Cat Clinic will try to contact me. In the event that I am unreachable and the procedure cannot be safely delayed, I choose the following: *
If a flea is found on my pet during its stay at the clinic, they will be administered a CAPSTAR tablet at my expense. *
Do you hereby give Pacific Cat Clinic formal consent to use pictures of your cat for social media and other general purposes? *

DENTAL EXTRACTIONS

 

A full dental examination cannot be completed until your pet is under anesthetic. Until this time, Dr. Bell or another authorized veterinarian will not know how many extractions, if any, are needed. The cost of extractions can vary greatly due to the difficulty level of the extraction. I agree to be responsible for these extractions if undertaken.

 

I agree to extractions *

If I am not available at the phone numbers provided, I understand that dental extractions will not be performed. If after 15 minutes I cannot be contacted, I understand that my pet will be awoken without extractions. I will be responsible for the cost of the current anesthetic plus the cost of re-anesthetizing my cat for future work.

 

Please verify that you are human *