Dental Release Form Your pet is scheduled to have a dental. This includes scaling the teeth, a fluoride treatment and a sealant, as well as anesthesia, pre-anesthetic blood work, an IV catheter and heart and respiratory monitoring.Any extractions will be at an additional price, depending on severity.How many, if any, teeth will need to be extracted will be determined during the doctor's examination during the dental procedure.You may authorize these extractions now or we can call you during the procedure, although this will add to your pet's time under anesthesia.It is imperative that we have a telephone number in which you can be reached, especially if you would like to be called while your pet is anesthetized. Pets Name (required) Owners Name (required) Additional Options Nail Trim - $21.00Microchip - $64.49Anal Glands - $25.70 Please read, select one, and digitally sign below I hereby authorize any extractions that may be necessary during my pet's dental procedure. I understand there is an additional cost for extractions, depending on severity.I would prefer to be notified during my pet's dental procedure of extractions needing to be performed. I understand this means my pet will be under anesthesia for an extended time.Yes, I understand the risks of both anesthesia and surgery. To reduce the risk, I understand that a pre-operative blood profile will be run to assess organ function. I also understand that my pet will be sent home with pain medication to be given at home. Digital Signature* Today's Date Phone number where you can be reached