CAT CLINIC OF CARY

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Pampered Pets Mobile Vets
PRE-ANESTHETIC CONSENT FORM
FOR DENTAL PROCEDURES
Owner:
Patient:
Date: ________
General anesthesia is required for this dental procedure. I understand that while every precaution will
be taken during any anesthetic/surgical procedure, there is always some element of risk. I also
understand that in the event of an emergency my pet will have emergency treatment provided at my
cost and as soon as possible the attending veterinarian will contact me regarding treatment options.
I assume full financial responsibility for my pet. I agree that if my pet is found to have internal or
external parasites, the pet will be treated at the discretion of the Pampered Pets Mobile Vets at my
expense. I understand that if I am late picking my pet up during regular office hours that I will be
charged to board my pet overnight.
I hereby certify that I have read and fully understand this authorization for this
procedure.
Signature: ____________________________________
Date: __________________
You can reach me today at ______________________________ (Telephone number)
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