Haven Lake Animal Hospital

300 Milford Harrington Highway
Milford, DE 19963

(302)422-8100

www.havenlakeanimalhospital.com


Dental Release Form

Dental Release Form

Client Name (required)
First Name (required)
Last Name (required)
E-Mail Address (required) :
Phone (Home) (required)
Phone TypePhone Number (required)
Phone (Cell)
Phone TypePhone Number
Phone (Work)
Phone TypePhone Number
Pet Name

Procedure

Date of Procedure

Your pet will be spending the day with us for a dental/periodontal procedure. He/she will be attended by a veterinarian and veterinary technician throughout their procedure.
All patients will receive an intravenous catheter for administration of sedatives and other medications. This requires one or two legs to be shaved. Once sedated, the veterinarian will fully examine the mouth to determine the need for radiographs, periodontal treatments, or extractions. YOUR PHONE NUMBER IS IMPORTANT IF ANY FINDINGS OF ESTIMATE OF SERVICES NEED TO BE DISCUSSED. If you are unable to be reached for approval of services, the attending veterinarian will treat your pet’s dental needs as he/she feels the animal would best be served.
Pre Op Blood Profile

Accept
Decline


Sanos Sealant Dental Treatment

Accept
Decline
I need more information


Is there a dental estimate?

Accept
Decline
I need one


I give permission for the veterinarian to treat my pet as deemed necessary, even if the veterinarian is unable to reach me. Treatment may involve: extractions, dental x-ray, nerve block, intravenous fluids, pain relief medication.

Accept
Decline


I would prefer to be contacted by the veterinarian with an estimated cost of necessary diagnostic and treatment procedures before anything is performed beyond an uncomplicated periodontal cleaning.
I UNDERSTAND IF I AM NOT AVAILABLE, THIS COULD DELAY TREATMENT FOR ANOTHER TIME RESULTING IN A SECOND ANESTHESIA AND ADDITIONAL COST.
I CAN BE REACHED AT THE PHONE NUMBER BELOW.

Accept
Decline


Phone
Phone TypePhone Number
Microchip

Accept
Decline
Already Done


While your pet is admitted in the hospital, all patients found to have fleas and/or earmites, will be treated at owner’s expense to decrease the spread of infection to others.
I understand that some risks always exist with anesthesia and/or surgery. You are encouraged to discuss any concerns you may have about those risks with the attending veterinarian before the procedure is initiated. Should some unexpected life saving care be required, Haven Lake Animal Hospital has my permission to provide such treatment.

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At Haven Lake Animal Hospital, we understand that you may feel a bit overwhelmed by it all, but rest assured that we are here to help and guide you and your pet through the process and back to health. If your pet has not recently been in for an annual wellness exam or dental exam, is not current on his or her vaccinations, or has any other issues you are concerned about, please contact us to schedule an appointment.

 

At Haven Lake Animal Hospital, we understand that you may feel a bit overwhelmed by it all, but rest assured that we are here to help and guide you and your pet through the process and back to health. If your pet has not recently been in for an annual wellness exam or dental exam, is not current on his or her vaccinations, or has any other issues you are concerned about, please contact us to schedule an appointment.