Cliftwood Animal Hospital - Dental Form Logo
  • Dental Cleaning & Procedure Admitting Form

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  • Elective Procedures to be Done Under Anesthesia

    These are simple procedures that do not greatly increase sedation/anesthesia time and therefore can be provided for a fee (avoiding additional sedation that would be required for the separate procedure)

  • Extraction & Other Procedures Consent/ Waiver

    Sedation is required before a thorough examination can be completed. The condition of each tooth must be evaluated before a decision is made as to the best course of treatment. Although no one likes surprises, it is impossible to give an accurate estimate before sedation. It is more economical to complete dental procedures during the initial visit and sedation rather than having to schedule another appointment with additional anesthesia. Please select the appropriate option below:
  • Pre-Anesthetic Screening and In Operative Procedures

    Like you, our greatest concern is the well being of your pet. A physical examination has been performed on your pet. However, many conditions, including disorders of the kidneys, liver, heart & blood cannot be detected without blood lab screening. For these reasons, we require pre-anesthetic blood work before anesthesia. All patients are monitored for heart rate and blood oxygen levels during procedures. Patients over the age of 5 years will have an IV catheter placed and maintained on IV fluids during their procedure.
  • Owner Release to Cliftwood Animal Hospital

    You are to use all reasonable precaution against injury, escape, or death of my pet. I understand that all sedation/anesthesiainvolves some minimal risk to my pet, but you will not be held liable in any manner whatsoever or under any circumstances inconnection therewith as it is thoroughly understood that I assume all risks. I have read the foregoing and agree.
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