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Pawsitively Dental

Consent Form

 

There are always risks associated with working with animals. Older dogs in particular are susceptible to having underlying and undiagnosed health issues. There is also a certain amount on unpredictability in the nature with working with animals. Pawsitively Dental will take every precaution to ensure your pet in handled safely and that they receive the best possible treatment while in our care. 

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By signing this form I,                                                                                                  the pet owner, acknowledge that there are inherent risks to my pet in the performance of these services including, but not limited to, cuts, abrasions, infection, illness, stress, undiagnosed dental issues or adverse reaction to any of the cleaning agents used. I agree that the services provided by Pawsitively Dental are provided sole at my risk, and hereby waive and release Pawsitively Dental, its directors, officers, employees, shareholders, volunteers, representatives and agents from and against any and all liabilities, claims, demands, causes of action, judgements, costs or expenses (including legal expenses) which Pawsitively Dental may suffer, sustain or incur as a result of any act or omission of any kind whatsoever arising out of, or in the course of the performance of the services. 

I understand and acknowledge that the representatives of Pawsitively Dental are not veterinarians and will not perform any veterinary medicine. I understand that sedation free cleanings are a hygienic service and not meant to replace visits to a veterinarian.                    Initial

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Owner(s) name(s):                                                                                                                                       

Address:                                                                                                                                                          

Phone:                                                                        Alternate Phone:                                                     

Email:                                                                                           

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By providing the above information you consent to Pawsitively Dental contacting you for reminders for future apps. Your information will be kept private, we do not provide information to third parties.

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Pet Information

Dog #1 Name:                                                                  Breed:                                                                   

Age:                                                                                     Allergies:                                                             

Medical Conditions:                                                                                                                                                                                                                                                                                                                   

Dog #2 Name:                                                                   Breed:                                                                 

Age:                                                                                     Allergies:                                                            

Medical Conditions:                                                                                                                                                                                                                                                                                                                   

 

I have been informed that my dog may have dental issues that should be seen by a veterinarian. I have been informed that anesthetic - free cleaning may not be sufficient for my dog to maintain their oral health. I understand that there are limitations to anesthetic-free cleanings, including the lack of any diagnosis or treatment. I have chosen to continue with an anesthetic-free cleaning, which may leave underlying issues unresolved.                                   Initial

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I have read & understand the above information and authorize the above payment to Pawsitively Dental.

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Signature:                                                                                                            Date: