Call 520.886.1125

180 N. Harrison Road
Tucson, AZ 85748 Map It
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HOURS
Mon-Fri 7:30am-5:30pm
Sat 9:00am-4:00pm
  • Home
  • Services
    • Comprehensive Physical Exam (more than a brief glance!)
    • Wellness Packages
    • Individualized Preventive Care
    • Pet Dental Care with Radiographs!
    • Safer Surgery
    • Behavior Therapy
  • Our Team
  • Appointments
    • Request an Appointment
    • Patient Forms
      • New Patient Registration
      • Prescription Request
      • Medical History Form
      • DROP OFF CHECK-IN CONSENT
      • CURBSIDE CHECK-IN FORM
      • SURGICAL/ ANESTHETIC CONSENT
      • Telemed Consult Form
      • DENTAL TREATMENT CONSENT FORM
      • Health Certificate Info
  • Blog
    • Telehealth Consults for Pets- Cimarron Animal Hospital
    • Curbside Check In and Telehealth Exams – Cimarron’s New Services
  • Pet Resources
  • Contact
  • Home
  • Services
    • Comprehensive Physical Exam (more than a brief glance!)
    • Wellness Packages
    • Individualized Preventive Care
    • Pet Dental Care with Radiographs!
    • Safer Surgery
    • Behavior Therapy
  • Our Team
  • Appointments
    • Request an Appointment
    • Patient Forms
      • New Patient Registration
      • Prescription Request
      • Medical History Form
      • DROP OFF CHECK-IN CONSENT
      • CURBSIDE CHECK-IN FORM
      • SURGICAL/ ANESTHETIC CONSENT
      • Telemed Consult Form
      • DENTAL TREATMENT CONSENT FORM
      • Health Certificate Info
  • Blog
    • Telehealth Consults for Pets- Cimarron Animal Hospital
    • Curbside Check In and Telehealth Exams – Cimarron’s New Services
  • Pet Resources
  • Contact

Dental Treatment Consent Form

  • Date Format: MM slash DD slash YYYY
  • I verify that my pet has had a Rabies vaccination and Upper Respiratory/Distemper vaccination within the last 1-3 years
  • EXTERNAL PARASITES: Pets found to have fleas or ticks upon presentation will be treated and charged accordingly ($15.00 for pets under 25#, $25.00 for pets over 25#) PRE-ANESTHETIC BLOODWORK Pre-Surgical Lab Testing appropriate to your pet's age and health status has been performed or will be performed prior to giving any medications.
  • ANESTHESIA: I authorize the use of appropriate anesthetics and other medications. I understand that during this procedure(s), unforeseen conditions may be revealed that necessitate an extension of the same or different procedure(s) than set forth above. I also understand that, despite pre-surgical exams and diagnostics, unforseen conditions may exist that may cause unexpected anesthetic complications. I authorize the Doctors and Staff to do everything within their power to prevent anesthetic complications.
  • In the unlikely event of Cardiac Arrest, I authorize the following:
  • In the event that I can not be contacted during my pet's procedure, I authorize the Doctor to perform extractions that are deemed necessary and will only be performed when the Doctor determines that the tooth can not be saved.
  • Oravet can be applied after the teeth are cleaned to reduce the build-up of new plaque. This is especially helpful for small breeds and dogs prone to rapid tartar accumulation. Follow up home care, once a week, is important to continue the benefit of this treatment
  • I would also like the following procedures performed
  • It is CRITICAL that we have contact information so that you can be reached throughout the day in case of Emergency or the Doctor needing to discuss your pet's condition. Preferred Method of Communication Today:
  • I authorize a Dental Treatment (General anesthesia/ Dental Radiographs/ Dental Cleaning) to be performed on my pet in my absence. I further authorize any other procedures that I have indicated in this document. I have been advised as to the nature of the procedure(s) and the risks involved. I realize that results cannot be guaranteed. I agree to pay for all services rendered at the time of my pet's discharge regardless of outcome.
  • Date Format: MM slash DD slash YYYY

For Emergency Pet Care After Hours, Please Call (520) 886-1125

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