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Dental Consent Form

Ensuring Your Pet’s Oral Health. Complete our dental consent form before your pet’s dental procedure.

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Preparing for Your Pet’s Dental Procedure

Good oral health is essential to your pet’s overall well-being. If your pet is scheduled for a dental cleaning or extraction, please complete our Dental Consent Form before their appointment. This form allows us to ensure a safe, effective, and stress-free procedure for your pet.

How-to-Fill-Out

How to Fill Out the Dental Consent Form

  • Confirm Pet & Procedure Details – Verify your pet’s name and dental service (cleaning, extractions, X-rays).
  • Anesthesia Authorization – Acknowledge that anesthesia will be used during the procedure.
  • Emergency Contact Information – Provide a number where you can be reached during the procedure.
  • Tooth Extraction Consent – Approve potential extractions if deemed medically necessary.

Filling out this form in advance ensures we can focus on providing the best dental care for your pet without administrative delays.

Dear Client,


Your pet is scheduled for an upcoming surgery. To assist all of us in making the surgery day as easy and stress-free as possible, we have put together some simple forms for you to sign and review in advance. In addition to this letter, you will find that the following forms are provided on our website for review:

  • Pre-Anesthetic Blood Testing Information Form
  • Surgical Information Sheet

Please carefully go over all forms provided. If you have any questions, please feel free to call or email the hospital at 555-555-5555 / hello@chukaanimalclinic.com. On your pet's surgery day, you will be required to review and sign an Authorization/Estimate Form. We will also double-check to ensure we have a phone number where you can be reached during your pet's surgery time.


The night before your pet’s surgery, we ask that you refrain from providing any food or treats after 10:00 pm. Water is fine and may be left out for your pet to consume. If you are currently administering any medications, vitamins, and/or injections, withhold the morning doses unless otherwise instructed by the doctor.


At the time of your pet's scheduled surgery, the doctor will address any remaining questions or concerns you may have and will collect the Authorization Form that you have completed.


If you have elected to have any of the recommended blood tests performed, these will be collected and done prior to the start of surgery, if not already performed in advance. If any questions arise, the doctor may contact you at the number on the Authorization Form.


Upon the completion of the surgery, the doctor will process your payment, go over all discharge orders verbally, and provide you with a written copy. If you do not understand any instructions, please do not hesitate to ask for clarification prior to or after our departure.


We know surgery days can induce stress and anxiety. Chuka Animal Clinic appreciates the trust you place in us, and we want to make the experience as pleasant as possible for both you and your pet.


We look forward to serving you and your pet on the upcoming surgery day.

Clear Signature

Schedule Your Pet’s Dental Procedure

Your pet’s dental health is just as important as their overall wellness. Complete the form and schedule their professional cleaning or treatment today!