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Pickrell Veterinary Clinic - Dental Form 

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    Please read all the information below BEFORE initialing AND circling

    I realize there are anesthetic risks involved as well as risks associated with medical and surgical procedures. Such risks include, but are not limited to, fracture of the maxilla or mandible with tooth extraction or a reaction to the anesthesia or administered medications resulting in the death of my pet. I hereby release Pickrell Veterinary Clinic and its owner(s) and employee(s) from all responsibility of such complication(s). The procedure and my financial obligations have been explained to me to my satisfaction. I realize that no guarantee nor warranty can be ethically or professionally made. I am also aware that the price quoted me is the projected price of the procedure to be done with my pet for services paid in full at time of service. I am aware that some variables could result in a change in price (including but not limited to increased bleeding or surgery time, extractions, etc.).

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    I understand that these diagnostic tests are recommended for the anesthetic safety of my pet and as screening tests for illness associated with infection and changes in organ function which may affect how my pet tolerates anesthesia. This is an additional $80.
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    I understand that I assume financial responsibility for all services rendered, payment is considered due when my pet is discharged from the clinic, and prices quoted are for services paid in full at time of care (any applicable discounts for paying at time of service may be voided if the balance is not paid in full at time of service). Down payment may be required before hospitalization, medical, or surgical care. Pickrell Veterinary Clinic reserves the right to refuse hospital admittance and treatment. If the pet has already been admitted, Pickrell Veterinary Clinic reserves the right to refuse release of the pet until payment arrangements are made to the satisfaction of the clinic.

    Bundles include IV catheter + fluids, pre-anesthetic diagnostic testing (not heart test), dental x-rays

    Grade Normally Bundle Pricing
    Grade 1-2 = $106 $336 $255
    Grade 3 = $145-$155 $375-$385 $300
    Grade 4-5 = $165-$175 $395-$405 $350

    Dental procedures include anesthesia, injectable medications around the time of the procedure, visual examination, cleaning, and probing of each individual tooth, anesthetic monitoring and after care during hospitalization. Mobile or otherwise severely diseased teeth that can be manually removed during the procedure will be (or will be attempted) manually removed - this will be an additional charge of $10/tooth up to a maximum charge of $60. Often teeth cannot be removed by hand and need to be surgically extracted. Since we cannot determine this prior to examining the teeth under sedation, the best evaluation (and estimate) is made during the procedure.

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    *Rabies vaccination must be current for all surgery patients. If proof of vaccination is not provided we will administer the vaccine and owner will be charged.

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