Dental Consent Form

Your Name*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone number that I can be reached at at any time during the duration of my pet’s procedure today:*
Your Cat's Name*
Procedure being performed today:*
Estimated cost of services you have been provided for today’s visit:*
Please read the following in full prior to completing.
I understand that to avoid the spread of fleas and ticks in hospital, any cat with fleas or ticks will be treated for these at the owner’s expense ($30-$35). This amount is in addition to the estimate I have been provided for the procedures being performed today.
Initial Here*
The Feline Hospital has been authorized to provide general anesthesia and dentistry on my cat today. I understand the nature(s) of the procedure(s) being performed today, and have been provided an estimate for the cost associated with such procedures. I have been advised as to The Feline Hospital’s recommendation of pre-anesthetic labwork prior to my cat undergoing general anesthesia,* and have been given the opportunity to have this bloodwork performed. I understand that The Feline Hospital and its associates make no guarantee regarding the outcome of today’s procedure. I understand that unless other arrangements have been made prior to the date of dental surgery, that I will be responsible for rendering payment in full for any services performed on my pet.
Initial Here*
I understand that in the event that I am unreachable by phone and cannot approve or decline any procedures that the doctor determines to be in the best interest of my pet, I authorize The Feline Hospital to make the treatment decision in my pet’s best interest and that the cost associated with that procedure may or may not be included on any written or verbal estimate I have been provided prior to the day of surgery.
Initial Here*
The Feline Hospital has the ability to perform CPR in the event of an unforeseen complication or emergency. There may be additional costs to perform CPR if it is needed, and there is risk of injury associated with the acts required in performing cardiopulmonary resuscitation. I understand that the approximate percentage of my pet making a full recovery after suffering a cardiopulmonary arrest are less than 10%. By approving CPR, I understand that there is no guarantee of a positive outcome for my pet and I agree not to hold The Feline Hospital responsible for any outcome.
Please choose one*
- I would like to have CPR performed on my pet in the event of an emergency.
- I would not like for CPR to be performed on my pet in the event of an emergency.
By typing your name below in lieu of a written signature, you acknowledge that you have read and understood the previous statements.
Client’s Full Name (Typed)*
Date
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Email
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Dental Consent Form

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