The following information is necessary in order to serve you better and give you more personal attention. Please fill out the form completely and double-check your personal information to be sure everything is current. I, owner or authorized agent of admitted patient, hereby authorize the admitting veterinarian (and his/her designated associates or assistants) to administer treatment as necessary to perform the following surgical, dental, or diagnostic procedure and additional procedures as are considered therapeutically and/or diagnostically necessary. I also consent to the administration of such anesthetic as necessary. I hereby authorize the performance of the following procedure(s): Surgical Dental Cleaning

In addition to the above procedure, while your pet is under anesthesia he/she may receive a complimentary ear cleaning and nail trim. If you would prefer that we NOT do these services, please let us know.

Pre-anesthetic Bloodwork - This is STRONGLY recommended for all patients and is REQUIRED for pets 10 years or older. Bloodwork helps identify pre-existing conditions that may or may not be physically evident and may affect the drugs we can use for anesthesia. Our blood profiles include measurements of your pet's liver and kidney function, red blood cell count, white blood cell count, platelet count, etc.  Cost is $92-$130

Tooth extractions - We cannot know if teeth will need to be removed until we have performed an exam under anesthesia.We only remove teeth that we feel are causing pain or could be a source of problems including infection. Often pets do not show outward signs of dental pain. If we feel teeth need to be removed, how should we proceed? Extractions vary on cost depending on the type of tooth and extent of disease and can cost $20-$150 per tooth.

Dental radiographs - Dental radiographs help us determine overall health of the teeth and jaw. They also help us determine if a tooth needs to be removed and if it can be removed safely. Radiographs are also very important when extracting teeth to confirm entire root was removed.

I further understand that no guarantee of successful treatment is made. I hereby certify that I have read and understand this authorization, the reasons that this procedure is considered necessary, as well as its advantages and possible complications if any. I will not hold Critter Care Animal Clinic, the doctors, or the staff liable for any complications. I assume financial responsibility for all charges incurred to the patient and agree to pay all charges at the time the patient is discharged. I understand that if my pet is not current on his/her rabies vaccination, it will be updated at the time of service. I also understand that any patients found to have fleas will be treated at the owner's expense.

I understand that there may be risk involved in these procedures. In the event of a cardiopulmonary arrest (loss of normal heartbeat and breathing), I understand immediate action must be taken.