Consent to Treat Patient

I certify that I am over the age of 18 and am the owner (or authorized agent) of the above-named patient. I authorize Veterinary Dental Service to provide treatment for my pet.

Payment Policy

A deposit will be required prior to all procedures with the remaining balance due upon discharge. I understand that all diagnostics, treatment and medication charges are in addition to any consultation or examination fees and I agree to pay all charges incurred at the time of service. If I do not pay I understand that past due accounts are subject to costs of collection, including attorney fees.

Referral Communications Policy

I authorize Veterinary Dental Service to share records and communicate with my pet’s Primary Care Veterinarian on my pet’s condition to provide continuum of care and keep my pet’s health care team apprised of all pertinent medical information.

I have read and agree to these terms and policies.