Your pet’s teeth are an important part of their overall health. We offer complete dental services using the most advanced equipment. This includes ultrasonic scaling, polishing, and root canals.

Dental Form

Anesthesia Disclaimer

Most anesthetic agents are relatively safe or they would not be used. But, all animals don’t react the same to drugs. So there is a small element of risk involved in placing an animal under anesthesia. I understand and am willing to accept this risk. I give permission for anesthesia to be used on ______________________________________.
Owner Name(Required)
MM slash DD slash YYYY

Permission Statement

I give permission for a Dental Cleaning to be done on the above animal. I understand Grayson Valley Pet Clinic will do their very best but there are no guarantees as to the outcome of the procedure(s).

Safety Disclaimer

At Grayson Valley Pet Clinic we strive to make our dental procedures as safe and risk free as possible. In order to do that, we recommend the following pre-operative tests. Please indicate the services you would like your pet to have. Also, while we have your animal sedated for the procedure we may find that some teeth need to be pulled or other issues need to be addressed. Additional costs will occur for those issues.
Post Op Pain Medication(Required)
CBC and Profile ($90)(Required)
EKG Monitor ($22)(Required)
IV & Catheter & Fluids ($40)(Required)
Dental X-Rays ($80)(Required)

Permission Statement

While we have your animal sedated, we may find that additional services are needed. We will try to call the owner at the number provided today. If we are unable to speak with someone, please place your initials in the appropriate box.
Permission Checkbox