I am the owner, or the designated representative for the owner, of the above named pet. I authorize Southport Veterinary Center to administer anesthetic and appropriate medications to my pet, for the dental procedure to be performed. I understand there are potential risks when using anesthetics and performing dentistry/surgery and that no results can be guaranteed.
In addition to the estimated oral examination, dental x-rays, scaling, root planing and polishing treatment, I authorize the following elective procedures while my pet is under anesthesia.
It is often necessary to speak with you after the initial cleaning has been completed due to the discovery of certain unexpected dental problems.If we cannot reach you by telephone, please indicate which one statement best applies:
Additional charges will apply for any procedure beyond basic cleaning. I agree to pay in full all fees for services performed at the time they are rendered.
