Owner's Name *

First

Last

Pet's Name *

When my pet's dental procedure is completed, please contact me by (select ONE below): *

Phone
Text

Phone *

Alternate Phone

Texting Number *

What procedure(s) are you expecting to be done today? *

Please list all medications given in the last 72 hours, and when given. This includes prescription and over the counter medications.

* In the event that additional services may be needed, to ensure the health and safety of your pet prior to the scheduled procedure, we will attempt to contact you with the given information above. Failure to be reached on the day of the procedure may result in postponement of the surgery/treatment. *

Please review the options below and select ONE option that will allow us to provide the best care for your pet today: *

Please do what you believe is in the best interest for my pet while in your care, regardless of additional costs.
Only perform and complete the treatments we have discussed and scheduled, please contact me before any additional procedures.

Parvin Animal Clinic strives to offer the best care and medicine to our patients, and by doing so we like to recommend the following services. Please review and select any additional services you would like for your pet to have today.

Dental X-Rays

Dental X-Rays (included and mandatory for both level 3 and level 4 dentals)

We recommend full mouth dental x-rays for all pets having dental procedures done. This procedure allows us to detect disease that is hidden below the gumline and establish a baseline for the future.

Pain Management (mandatory for dentals with extractions)

Pain Management (mandatory for dentals with extractions)

Dental procedures and dental extractions can cause pain and discomfort at times, which require pain management. These cost approximately:

(Canine injection and oral)- $40-$80 (Price varies based on weight)
(Feline injections) - $40-$80 (Price varies based on weight)
(Feline oral) — (approx. $30)

Please select ONE: *

Yes, microchip my pet
No, do NOT microchip my pet
Already microchipped

The cost of a microchip is $68.00. We offer a 10% discount off of microchips when they are implanted while under anesthesia. This permanent chip is registered with the information you provide when registering online.

We provide bedding and all essential necessities for your pet. If you are leaving personal items, please list all belongings below.

Please specify.

option the and

Disclaimer: Kennels are sanitized daily and ALL bedding will be washed and dried. Parvin Animal Clinic is not responsible for items lost or damaged.

I certify that I am the owner, over the legal age of 18, and financially responsible for the above-named animal, and that having understood the risks involved, including death, I have the authority to grant you my consent to receive, prescribe for, treat, induce anesthesia, and/or operate on my pet. All charges, including boarding costs (if necessary), shall be paid upon release of my pet from Parvin Animal Clinic.

After carefully reading the above, I have signed in agreement.

Signature *

Clear Signature

Date *

Dental Consent Form

Dental Procedure Consent at Parvin Animal Clinic in Spanish Fort, AL

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