By checking he box below I understand that the purpose of this dental procedure is to sedate my pet and perform dental radiographs to determine any pathology that may be present in my pet’s mouth.  I authorize general anesthesia and understand the risk involved. I understand and authorize that any and all extractions necessary can be performed for the longevity and health of my pet.  I understand that some gum tissue may be found and need to be biopsied or removed.  I understand that it is not possible to determine how many extractions are necessary until dental radiographs have been completed.  I understand that the cost of such procedures is as follows:

Extractions grade 1         $35.00                          Extractions grade 2         $45.00

Extractions grade 3         $95.00                          Extractions grade 4         $195.00

Gingival surgery                $45-75.00                                 Dental Radiographs          $180.00

I understand that for the best interest of my pet that an IV catheter will be placed causing a small area of fur to be clipped on the front leg.  I authorize Marina Vet Mobile to perform surgery on my pet.  I understand that there is always a risk involved with anesthesia and  dental procedures.  Furthermore I authorize the doctor and staff in an emergency situation to use their best judgement in the best interest of my pet.  This may involve cancelling the surgery if any complications arise and I am aware that I would still be financially responsible for the anesthesia and any initial procedures that have been started.  Should any emergency occur I authorize my pet to be resuscitated and assume all costs ranging from $100-200.

 By checking the box below I authorize and consent to the above procedure.

Please check ONLY ONE of the next two options :

OPTION ONE BELOW:

Please proceed with any and all extractions necessary for the health of my pet and understand that this may exceed the “estimate” given to me prior to my pet’s sedation.

OPTION TWO BELOW:

I would like to be called prior to proceeding with any extractions at the number above.  I understand that if I cannot be reached(including missing call, not calling back or not hearing phone for any error whatsoever) my pet will be kept under anesthesia for no longer than 5 minutes before being recovered. Should my pet be woken up I will have to have my pet resedated at an additional charge to have such extractions or treatments performed.