Clone of Surgical Consult Form

Dental Consult Form

Please fill out the following information so that our veterinary team can review.
We understand that sudden or larger veterinary costs can be difficult, and we’re offering dental surgery procedures at a reduced cost to help for the month of October.

Each form submitted will be reviewed by a veterinarian, and approval is decided on a case-by-case basis. Submitting this form does not guarantee an appointment, but if accepted, cases will be scheduled as timely as possible based on need and availability.

If your application is accepted, you will then be called to have your pet scheduled in for a pre-surgical examination with our veterinarian before their dental surgery is booked.

Pre-surgical examination (REQUIRED): $40.00 (Will be deducted from final surgery invoice) Please E-Transfer appointment holding fee to bgah@bgah.com.

Dental Surgery Special: $925.00+tax

This offer is in accordance with our high volume/high quality spay neuter program to provide the community with reduced dental costs for their pets.
How urgent is your pet’s medical need?*

Moderate Priority (within 1–2 weeks): Condition is causing ongoing pain, discomfort, or interfering with normal activities.Low Priority (flexible): Condition is stable, not painful, and not affecting quality of life
Owner's Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Patient Information
Pet/Patient Name
Species

DogCat
Breed
Age
Gender

Male, IntactFemale, IntactMale, NeuterFemale, Spayed
Reason for Dental Consult*
Has your pet been examined/diagnosed by a veterinarian for dental disease? If so when and where did this occur?*
Does your pet require any teeth extractions?*

YesNoUnsure
Does your pet have any of the following medical conditions listed below?*

Heart Disease (including heart murmur)Kidney DiseaseLiver DiseaseOtherNone
To provide the best and safest care for your pet, we require a copy of their medical history from your current or previous veterinarian. Please contact your veterinarian’s office and ask them to send your pet’s medical records directly to us so our veterinarian can review.

📌 Records can be emailed to: bgah@bgah.com

This ensures we have a complete and thorough understanding of your pet’s health prior to surgery.
Is your pet aggressive and/or requires a muzzle/medication for appointments?*

YesNoUnsure (we will call to discuss)
Please list all current medications and any additional notes for staff:*
I understand and agree that:*

Submitting this form does not guarantee my pet will be accepted for surgery.Acceptance is based on several factors, including the condition being treated, staffing availability, and the medical needs of other animals.This is not a free program—fees will still apply. The goal of this program is to help reduce costs, not eliminate them.Final approval and scheduling are determined by a veterinarian on a case-by-case basis.I understand that Bright's Grove Animal Hospital does not have emergency or after hours care. Any assistance out of business hours is at my cost (the owner of the pet) and will not be refunded by BGAH.I have submitted my $40 appointment holding fee to bgah@bgah.com
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Dental Consult Form

Patient Information