Dental Consent Form

Please fill out the new patient form.

First Name

Last Name

Email Address

Phone Number

Pet Name

Special Instructions

Extractions will be done if needed under doctor discretion.

I have read and understand

Payment is expected at the time services are rendered. The balance is due before your pet is released from the hospital. We realize that veterinary services may become necessary at times that are financially inconvenient; therefore, we accept cash, VISA, MasterCard, Discover, American Express and Care Credit credit cards. In order to keep our veterinary costs to a minimum, we cannot extend the privilege of charging services as this puts us in the position of becoming a lending institution.

I have read and understand

I am the owner (or authorized agent for the owner) of the above named animal and have the authority to execute this consent. I hereby authorize the above procedures by the clinic veterinarians and staff which may include diagnostic, therapeutic, surgical or preventative procedures and to administer sedation and/or anesthesia as deemed necessary. Further, I understand why such procedures are necessary, their advantages, and possible complications. No guarantee of successful treatment is made or implied.

CPR/DNR: Badger Veterinary Hospital requires a CPR/Code status prior to any animal remaining in the clinic without the presence of the owner in the building. If my pet enters a state of Cardiopulmonary arrest, when the heart or breathing stops, I understand that the staff of BVH will make every effort to contact me. In the event, that I am unreachable:

I consent to the initiation of CPR on my pet (additional fees will apply) - I acknowledge that if staff is unable to reach me after initiating CPR for 10-15 mins and if deemed medically necessary, as determined by a doctor, all further CPR procedures will cease.

I DO NOT wish for CPR to be performed on my pet and authorize a Do Not Resusitate (DNR) status.

I assume full responsibility for all charges incurred for this case and agree that payment of these charges will be made or arranged for before the animal is released.

Yes

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Dental Consent Form

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Dental Consent Form

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