Dental Admission Form

Client Name: ______Patient Name:______

In an effort to provide the best possible service for you and your pet, please take a moment to read and complete this form. Routine dental cleanings for pets involve procedures similar to those performed on human patients. Our cleanings include: scaling, polishing, antibiotics, and pain medications.

Extractions: ($10-$30 per extraction)

The most common dental problem seen in dogs and cats is periodontal disease. After removing dental tartar, we frequently find that a tooth or teeth have become loosened, abscessed, or have root exposure; which results in pain for your pet, and the tooth or teeth must be removed. If your pet should need one or more teeth extracted, it is necessary for the doctors at Heartland Animal Hospital to do so. If extraction(s) are necessary for the health of your pet, there will be an additional charge for this procedure. Postponing the extraction(s) to a later time will result in a separate anesthesia/sedation charge.

Antibiotic Therapy:

Antibiotic therapy is needed after dental procedures due to the release of bacteria from the teeth. Every patient receiving a dental procedure will receive an antibiotic injection while under anesthesia; most patients will be prescribed additional antibiotics to be given at home.

Pain Medication:

Although pets are skilled at disguising their pain or discomfort, dental procedures (especially extractions) can cause pain. Therefore, the doctor will determine the need for, duration of, and type of pain medication to be given post-operative.

Dental Sealant:

Oravet™ is an invisible barrier sealant which is applied to teeth after cleaning to prevent bacteria and plaque from adhering to the teeth and extending the results of your pet’s dental cleaning. Oravet™ is also available in an at-home kit which is applied weekly to slow the rate of tarter accumulation.

Please apply Oravet™ Sealer today ($25.77) I would like to purchase at-home kit ($41.53)

I decline Oravet Sealer I decline at-home kit

CET Rinse:

We also offer a convenient oral rinse that can be used daily to promote dental health. The CET rinse is simply squirted into your pet’s mouth after meals or whenever additional freshness is needed.

I would like an 8 oz bottle ($24.71) I decline CET Rinse

Signature: ______Date: ______