I agree that I am the owner, or agent, of the pet identified above, over the age of 18, and authorize the veterinarians at Waverly Animal Hospital to perform the above procedure(s).
I have been informed that my pet is in need of preventative or therapeutic dental care and hereby consent to the appropriate procedure(s) described to me by staff veterinarians at this facility. These procedures may include, but are not limited to, the following: 1) dental prophylaxis (routine cleaning and polishing), 2) extractions, 3) oral surgery to close gaps left by extractions, 4) dental x-rays, and 5) antibiotic gel implants.
I am aware that dental procedures for animals require the use of anesthesia to: 1) maximize the visualization of the gums, teeth, and oral cavity, 2) minimize movement and discomfort, and 3) provide for the safety of the pet, doctors, and hospital staff.
I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending doctor before the procedure(s) is/are initiated. These may include, but not be limited to: the reasonable medical and/or surgical treatment options available, sufficient details of the procedure to understand what will be performed, how fully your pet will recover and how long it will take, the most common and serious complications, the length and type of follow-up care and home restraint required, and the estimate of the fees for all services. Nevertheless, all questions and concerns about the recommended dental procedures have been answered to my satisfaction.
While I accept that all procedures are performed to the best of the ability of the staff at this facility, I certify that no guarantee or warranty has been made regarding the results that may be achieved.
I agree to pay a deposit of 50% of the estimated fees, or $200, whichever the doctor requests prior to drop-off and assume financial responsibility for the remaining fees, agreeing to provide payment via cash, credit card, or check at the time my pet is discharged.