Dental and Anesthesia Release: Feline Dental in Portland, TX

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Owner*

Patient*

Procedure*

Is your pet on any medications?*

Date Checked In*

Pick-up Date*

Phone where you can be reached today*

I hereby authorize Drs. Fontanez of Portland Veterinary Hospital to perfom the above stated procedures, as well as any other treatments that they deem necessary for the health and well-being of my pet while under their care. I undersrand that I will be informed of any changes in the estimated fees due to unforeseen circumstances. The nature of the procedure has been explained to me and NO guarantee has been made as to the results or cure. I understand that there are always risks involved with any surgery or anesthetic protocol, but that precautions will be taken to minimize risks as much as possible. I understand that my pet will be released during office hours only, and that FULL PAYMENT IS REQUIRED UPON RELEASE OF MY PET.

I understand that should my pet injure itself in an attempt to escape, refuse food, suddenly become ill and die, or succumb to the effects of natural disasters (hurricanes, lightening, tornadoes), I can not hold Portland Veterinary Hospital liable in the absence of gross negligence as provided by state law.

Feline Dental

Owners will be charged a minimum of $8 per tooth extraction if needed

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All pets will receive a Capstar if not on oral flea control

Dental, Fluids, and Pre-Anesthetic Bloodwork including a CBC (complete blood count), Chemistry (to tell us about liver, kidney function, and electrolytes), PT/PTT (to check clotting factors)

Dental, and IV Fluids (Required)

Pain Injection ( If Needed )

Nail Trim

Medication to go home Approximately

Prices noted are estimated costs subjected to change

Total

Signature*

Date*

Product Name