Non-Anesthetic Dental Release Form (please read first before filling out the form below).

 

We offer scaling and polishing of the teeth without putting your pet under anesthesia.  The teeth are examined and charted; any problems are documented and can be addressed by the doctor and later discussed with the owner.  We recommend an anesthetic dental every other year or sooner if there are problems, as we are unable to x-ray the teeth on an awake pet. 

Requirements for Anesthesia Free Teeth Cleaning:

  1. No age requirement.
  2. Patients must have good temperament; most patients are doing very well with gentle handling techniques.
  3. Patients must be current on vaccinations and have a negative intestinal parasite screening; we can update these on the same day they are scheduled for teeth cleaning (see details below).
  4. Patients must not be sick at the time of the procedure. 
  5. Patients with severe dental disease, periodontal disease, bad gingivitis, loose teeth must have anesthetic teeth cleaning.

 

We can update vaccinations and additional testing as needed for a cost of $85 for CATS and $113 for DOGS (we will only do what is needed, so the cost will be reduced if some vaccinations/testing aren't needed). 

 

Please fill out the form below to expedite your check-in on the day of the procedure.

Form - Non-Anesthetic Dental Form

Name (required)
First Name (required)
Last Name (required)
Your Pet's Name (required)

Phone Number (where you will be available during the procedure) (required)
Phone TypePhone Number (required)
May we use the number above to text you information about your pet?
yes
no

Alternate Phone
Phone TypePhone Number
May we use the number above to text you information about your pet?
yes
no

E-Mail Address :
Authorization
I am the owner or agent of the above described animal and have the authority to execute this consent. I hereby consent and authorize the performance of a Non-Anesthetic Dental.
Explaination and Requirements for a Non-Anesthetic Dental:
We offer scaling and polishing of the teeth without putting your pet under anesthesia. The teeth are examined and charted; any problems are documented and can be addressed by the doctor and later discussed with the owner. We recommend an anesthetic dental every other year or sooner if there are problems, as we are unable to x-ray the teeth on an awake pet. Requirements for Anesthesia Free Teeth Cleaning: 1. No age requirement. 2. Patients must have good temperament; most patients are doing very well with gentle handling techniques. 3. Patients must be current on vaccinations and have a negative intestinal parasite screening; we can update these on the same day they are scheduled for teeth cleaning (see details below). 4. Patients must not be sick at the time of the procedure. 5. Patients with severe dental disease, periodontal disease, bad gingivitis, loose teeth must have anesthetic teeth cleaning. We can update vaccinations and additional testing as needed for a cost of $85, for CATS and $113 for DOGS (we will only do what is needed, so the cost will be reduced if some vaccinations/testing are not needed).
In the event that my companion animal arrests while hospitalized at Hebron Cat Hospital
I authorize the following CPR code: (required)
(by making your selection, you are initialing your choice)
Normal CPR: involving chest compressions, oxygen therapy and medications such as epinephrine, atropine, etc
DNR: No resuscitation

I understand that if my pet is due for vaccines or testing, I will be charged an additional amount.
I understand that if sedation (not anesthesia) is needed, I will be charged an additional $42.21
I understand that I will be charged for flea medication administered if evidence of fleas is found.
Furthermore, I understand...
...that during the performance of the procedure(s) that I have authorized, unforeseen conditions may arise. Therefore, I hereby consent to and authorize the performance of such procedures as are necessary in the exercise of the veterinarian's professional judgment. I also do hereby acknowledge that I understand that there are no guarantees either expressed or implied that the procedures authorized will be without complications from unexpected events beyond the veterinarian's and hospital's control.
I have read and understand this authorization and consent. (required)


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