• Surgery Request Form

    Low Cost Dental Clinic
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  • One pet per submission. Program cost is $750 and includes the pre-exam, transportation to the Placerville clinic with drop-off and pickup in Natomas, dental cleaning, necessary extractions, and post-op medications as prescribed by the veterinarian.
  • Pets aged 8 years or older require blood work; program-arranged blood work costs an additional $150. Optionally, you may get tests done elsewhere and submit blood work results for our reference. Bloodwork must be within 1-2 months of the request/surgery date.
  • Learn more: https://catsabouttown.org/low-cost-dental-surgery/

  • Client Information

  • Format: (000) 000-0000.

  • Pet Information

  • Animal Type*
  • Sex*
  • Spayed or Neutered*
  • Hair Length*

  • Dental and Medical Information

  • What dental problems/symptoms are present? (check all that apply)*
  • When was your pet last seen by a veterinarian?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Has your pet had recent blood work within the last 1–2 months?*
  • Do you have any recent vet/medical notes regarding your pet’s current dental issues?*
  • Have you received outside estimates for dental treatment?*
  • Do you need to rent a hard-sided carrier for $20?*

  • File Uploads and Required Acknowledgments

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  • Upload a File
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  • Upload a File
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  • Blood work is required for pets age 8 or older to help determine whether they are healthy enough for surgery.

  • This program is generally limited to dogs under 30 pounds. Exceptions may be possible and require an additional fee. A volunteer will contact you to discuss your request.

  • This program does not provide emergency veterinary care. If you believe your pet needs urgent medical attention, contact your veterinarian or an emergency veterinary clinic immediately. Do not wait for a response to this request form.
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