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Pet's Name *

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I consent to receive SMS text messages from Alamo Area Veterinary Clinic. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

A dental exam can help us understand your pet’s oral health and aspects of your pet’s overall health. However, a thorough exam of your pet’s mouth, teeth and gums cannot be accomplished without the use of anesthesia. In order to minimize the time that your pet is under anesthesia, it is important that we have clear instructions from you in advance with respect to how you would like us to treat any condition that we may discover during the dental exam.

Please Choose One *

I prefer Alamo Area Veterinary Clinic to proceed with any extractions. I understand that I will be responsible for additional costs incurred by the authorization to proceed.
I prefer to be phoned prior to any extractions, at the above phone number. However, if I cannot be reached, I authorize the extractions to be done. I understand I will be responsible for additional costs incurred by the authorization to proceed.
If I cannot be reached, I DO NOT authorize any extractions to be done.

Additional Procedures?

Would you like Pre-Anesthihc ECG - to check for heart problems such as an irregular heartbeat. These will be evaluated by a cardiologist by “telemedicine” and is strongly recommended for any pets that have existing heart problems or have had anesthesia problems in the past.The fee is an additional $100.00 *

Yes
No

PETLINK™ MICROCHIPPING is offered as a permanent identification.It is a small chip that is implanted under the skin while under anesthesia so your pet will not feel any pain. You will register with a national registry and they will contact you if your pet is ever found and scanned by a shelter or veterinary hospital. The chip is ISO compliant which means it can be read by all readers.The fee is an additional $76.25 *

Yes
No

I, the owner or authorized agent for the owner of this animal, give my permission for anesthesia and the following procedure(s) to be performed. I understand that during the procedure(s) unforeseen conditions may be revealed that necessitate extension or a change in procedure(s). Thereby I authorize and give my consent for the performance of any procedure(s) that is/are deemed necessary by the attending veterinarian(s). I understand the risk associated with anesthesia and give Alamo Area Veterinary Clinic permission to perform any emergency procedure(s) deemed necessary. I am aware that I am financially responsible for the resulting fees for the additional procedure(s). *

I have read and understand

There is a $100.00 fee if you do not show up for your surgery or cancel within 48 hours of the surgery date. *

I have read, understand, and agree.

The fees associated with these services have been explained to me, and I agree to pay such fees in full at the time my pet is released from the hospital. *

I have read and agree

Today's Date *

alamo area veterinary clinic

Dental Consent Form

Dental Consent Form

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