Golden Lantern AH - ANESTHESIA FREE DENTAL CONSENT FORM

1
You are dropping your pet off today for an anesthesia free dental cleaning.To better serve you and your pet we need permission for the following:
Pet Name
2
I authorize Golden Lantern Animal Hospital to perform an anesthesia free dental cleaning
Yes
No
3
I authorize the Doctors at Golden Lantern Animal Hospital to sedate my pet IF necessary for the anesthesia free dental cleaning
Yes
No
4
I authorize Golden Lantern Animal Hospital to run any necessary lab tests such as: Blood work, Urinalysis, Fecal tests and X-rays
Yes
No
5
Golden Lantern Animal Hospital is authorized to proceed with any treatment, beyond physical exam and lab tests, without an estimate and my permission.
Yes
PLEASE CALL FIRST
6
I UNDERSTAND THAT THERE MAY BE SERVICES THAT MY PET MAY NEED TODAY THAT MAY NOT BE DISCOVERED UNTIL WE ARE DOING THE PROCEDURE. I FURTHER UNDERSTAND THAT THE HOSPITAL WILL CALL ME AND ADVISE ME OF ANY FURTHER TREATMENT MY PET MAY NEED AND WILL MAKE MYSELF AVAILABLE BY PHONE.
7
Signature* This field is required.
Clear
8
Phone Number* This field is required.
9
Email
example@example.com
Should be Empty: