Owner’s Name* First Last Pet’s Name*A pet dental exam can help us understand your pet’s oral health and aspects of your pet’s overall health. As part of your pet’s dental exam and cleaning, we will chart their oral health and add that to the permanent health record.During the exam, we may find teeth that require additional work. We will attempt to call you if unanticipated, non-emergency procedures are needed to correct your pet’s dental condition.However, when we have to call during the procedure, your pet is subjected to a prolonged anesthesia. If your permission cannot be obtained, your pet may need to have additional anesthesia and expense at a later date to complete treatment. Instead, if you would like to select one of the following options should unforeseen, non-emergency procedures become necessary.* I authorize Veterinary Wellness Center of Little Elm to proceed with all procedures. I prefer to be contacted prior to any additional procedures if the charges are in excess of the amount that I specify.The total charge of such additional procedures should not exceed.*300.00400.00500.00 If I cannot be reached, I do not authorize additional, non-emergency procedure.*** You as the owner will be financial responsible for the blood work if for any reason the procedure can't be done for abnormal blood work results.Date* Date Format: MM slash DD slash YYYY Signature*
