Ghent and Granby Vet Hospital - Dental Forms
Please review and sign these forms for your pet's upcoming procedure. If you have any questions, please call/text 757-351-0167 or email welcome@ghentandgranby.com
Your first and last name
*
Your pet's name
*
Type of pet
*
Canine
Feline
Other
Please select one of the following
I would like to come inside the hospital when dropping off and picking up my pet
I prefer curbside service when dropping off and picking up my pet.
Procedure Date
*
-
Month
-
Day
Year
Date
Signature - Consent #1 of 4
*
I hereby authorize Ghent and Granby Veterinary Hospital to perform the surgery listed on this estimate. I acknowledge that I am the owner/appointed caregiver of the animal described above. I understand that surgery poses a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver, I understand that by signing this Estimate, I agree to pay for all charges +/- 15% of the fees as shown on this Estimate and will pay the balance in full upon discharge. The surgery and relevant costs have been fully explained to me to my satisfaction.
Signature - Consent #2 of 4
*
I hereby authorize Ghent and Granby Veterinary Hospital to use general anesthesia on my pet for the above treatment/surgery listed on this estimate. I understand that anesthesia poses a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver, I understand that by signing this Estimate, I agree to pay for all charges +/- 15% of the fees as shown on this Estimate and will pay the balance in full upon discharge. The anesthesia and relevant costs have been fully explained to me to my satisfaction.
Dental - Recommended Treatments
*
I elect to have the doctor proceed with medically recommended treatments (including extractions)
I elect to have a phone call prior to any medically recommended treatments. I understand that if I cannot be reached by phone, my pet will have NO treatments performed and all further treatments including repeat anesthesia are at my expense.
Signature - Dental Recommended Treatments #3 of 4
*
Consent #4 of 4
*
MICROCHIP: Please microchip my pet today.
FECAL FLOAT: please perform a fecal float and evaluation for intestinal parasites.
HEARTWORM/EHRLICHIA/LYME/ANAPLASMA: please screen my dog for Heartworm, Ehrlichia canis, lyme, and Anaplasmosis.
TOE NAIL TRIM: please trim my pet's nails.
VACCINATIONS: please update my pet's vaccinations based on his/her lifestyle.
NONE OF THE ABOVE
Please select today's date
Primary Phone Number to be reached during procedure
*
-
Area Code
Phone Number
Secondary Phone Number to be reached during procedure
-
Area Code
Phone Number
Alternate Contact and Phone Number
Anything additional you would like to share?
Please note that this procedure is scheduled at our Granby Vet location (3415 Granby St. in Norfolk)
Save
Submit
Should be Empty: