West Boca Veterinary Center

NOTE: For pets over the age of 7 that have not had bloodwork performed within the last 3 months, extended preanesthetic bloodwork is required.

Please consent to ONE of the following options:

A. I approve any dental work you deem necessary. (biopsies, extractions)

B. I approve any dental work you deem necessary up to $_________

C. I request to be notified prior to performing ANY further dental services that are in addition to the standard dental cleaning fee.

NOTE: If you choose B or C, you understand that your pet will be under anesthesia longer as you are being notified, and accept the additional charges. Further you understand that if you are unreachable at the time, no further dental services will be performed and your pet will be recovered from anesthesia.

My pet has not had any food since last night. I am the owner/agent for the described animal and I authorize and request the services listed on this form. I understand and accept that when anesthesia is involved, there are always inherent risks, including death. Although West Boca Veterinary Center will use all reasonable precautions against injury, escape, or death of hospitalized animals, we cannot be held liable or responsible in any manner whatsoever, under any circumstances, on account of the care, treatment or safekeeping of the animal above. I understand I will be charged for flea/tick medication and a dose will be applied if evidence of fleas/ticks are found on my pet. I understand that all animals entering the hospital must be current on vaccinations, and any required vaccinations will be administered as necessary.