Dental Check-In Form

Thank you for choosing us!

We are so happy you have chosen us for your pet’s dental cleaning. We look forward to improving the health of your pet’s teeth.

Please Note: If your pet’s dental procedure requires anesthesia, please complete our Sedation Form as well.

Dental Check-In Form

Please fill out the following form before your dental appointment. If you have any questions, please contact us. Please Note: All * fields are required.

Name *

First

Last

Email *

Phone *

Pet Name *

Anesthesia

When your pet is here for a dental procedure and under anesthesia, our main focus is to keep them safe during the procedure. Prolonged anesthesia times are not uncommon in veterinary medicine. However, the shorter the procedure, the lower chance of any potential risks due to increased anesthesia times. PLEASE CHECK ONE OF THE FOLLOWING to help us keep your pet safe by avoiding unnecessarily prolonged anesthesia times.

Please check one: *

I agree to all necessary procedures, surgical or non-surgical extractions, that Dr. Diesel/Boggs find warranted and necessary during the dental procedure that is to be performed today and that I will be responsible for the cost.
Please call first; and if I am unable to be reached after ONE ATTEMPT, then I give full permission to do any necessary procedures (surgical or non-surgical extractions) that Dr. Diesel/Boggs find warranted during the dental procedure that is to be performed today. I am aware that I will be responsible for the cost.
Please call first, and if I am unable to be reached after ONE ATTEMPT, then I ask that Dr. Diesel/Boggs do not move forward with any procedures, surgical or non-surgical extractions at this time. I understand that by checking this option, even after the dental procedure, my pet could still experience pain, discomfort, and/or the dental/periodontal disease (if applicable) could progress quicker than normal. If any problems were discovered, I understand a second dental/anesthetic procedure would be required to correct them.

Date *

Dental Check-In Form

Thank you for choosing us!

Dental Check-In Form

Anesthesia

Yorkshire Animal Hospital

Contact

Hours

Location

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