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Countryside - Authorization for Dental Treatment Anesthesia Form
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    Pick a Date
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    To ensure your pet’s health and safety during surgery, we recommend blood work to check for liver problems, infections, and other health problems that may be missed with the physical exam.
    • Chem 17, electrolytes and CBC $152.56
    • PCV/Chem 10 $75.26 (Required for patients 8 years and older)
    • No, I decline the additional Bloodwork
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    I would like for the following options to be performed while my pet is here today: 
    Dremel Toenails     *    
    Microchip Implant     *    

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    If your pet is not currently taking any medications, please put "None".
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    Multiple Pets: Please initial if you would like for your pets to be kept in a cage together    *    
       

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    Due to the condition of your pet’s teeth, it may be necessary to do further treatments after the dental cleaning is complete. These treatments can include but not limited to Clindoral and Extractions.
    • Yes I give permission for additional treatments to be done while under anesthesia
    • I would like a call before further treatments
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    • Go ahead with the recommended procedures.
    • Wake up my pet up from anesthesia understanding that there will be unresolved medical issues and that there will be additional costs to address these issues at a later date.
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    • Text
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    Clear
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