I am the owner or the authorized agent for the owner of the animal named above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.

I have been informed that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian, including additional charges for severe periodontal disease and/or extraction of diseased teeth. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated.

I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication.

The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.

To prevent the spread of infectious diseases, all hospitalized (including dropped off) patients must be current on all vaccines and free from internal and external parasites. The signature below authorizes this level of preventive care and the appropriate charges will be assessed on the discharge invoice.

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.

In the event that the patient named above should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of patient named above's status?

By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion.

Rabies, DAP (dogs)/FVRCP (cats), and Bordetella (dogs) vaccinations are required to be up-to-date for hospitalization. They cannot be declined. They may not be administered at the doctor’s discretion. If vaccinated elsewhere, please provide proof of vaccination.

A Manhattan City License is required by law for all dogs and cats over 6 months of age that live in the city limits.

As stated in a previous section, there is an additional charge of $75 for severe periodontal disease. This is charged at the doctor’s discretion.

If extractions are not approved prior to the procedure and teeth are found that need to be removed, we will call during the procedure. If you are not able to be reached and do not return our call within 5 minutes, we will proceed without them as we do not want your pet anesthetized any longer than necessary. If necessary treatments are not able to be performed, an additional dental procedure will need to be done at your expense.

Our goal is to maintain your pet's teeth, not extract them. In some cases, teeth show early signs of disease that can be slowed or prevented altogether by applying a local antibiotic gel around the tooth. This treats infection locally and allows the gums to re-adhere to the tooth. This service is an additional cost, and is not required but highly recommended if these signs of disease are found.