Dental Form

Drop Off And Pick Up Times

• Drop off is at 7:30AM. Please note the clinic and doors open at 7:30AM.
• Bring your pet with this completed form.
• Please bring all your pet's medication and any records, radiographs, etc.
• All pain medication for your pet will be prescribed if needed, and will be an additional fee to the surgical cost on your final bill.
• Your pet will need to be picked up by 6:00 PM unless otherwise notified or your pet is hospitalized overnight.

BLOODWORK

ALLERGIES

EXTRACTIONS

***PLEASE HAVE YOUR PHONE AVAILABLE WITH YOU AT ALL TIMES WHILE YOUR PET IS WITH US TODAY IN CASE OF AN EMERGENCY OR IF DENTAL EXTRACTIONS ARE NEEDED.

BIOPSY

VACCINATIONS

FLEAS

MICROCHIPPING

ADDITIONAL TREATMENTS

PLEASE ANSWER THE FOLLOWING QUESTIONS

CPR CODE Consent Agreement

***Animals that have been successfully resuscitated are extremely critical and unstable. The likelihood of re-arrest is high and usually occurs within 4 hours of the initial arrest. If resuscitation is successful, there is only about a 20% chance that a pet will stay alive for the first 4 hours after resuscitation. The percentage of long term survival is even lower, and may be as low as 1%, depending upon what caused the arrest. Brain damage is common due to temporary lack of oxygen to the brain, which can result in blindness and/or impaired mental function, leaving a pet with physical and/or mental disabilities. This impairment may last for days, weeks, or years.

l am the owner or agent of the owner of the above named pet and hereby authorize the performance of treatment for this pet. I understand that unforeseen conditions may necessitate an extension of the treatment or a different treatment may be recommended and therefore authorize such treatments as necessary in the professional judgment of the veterinarian. I authorize the use of appropriate aesthetics and mediations in the treatment of this pet. I have and will be advised of the nature of the treatment and I understand that while every effort will be made to provide the best care for my pet, results cannot always be guaranteed. I understand that all fees must be paid in full at the time of release unless other arrangements have been made in advance with the veterinarian, medical director or with the practice manager of Northgate Animal Hospital. I have read the above information: I understand and agree to the conditions and policies of Northgate Animal Hospital.