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I, the undersigned, certify that I am the owner, or authorized agent for the owner, of the animal listed above. I authorize the Veterinarian(s) and staff of Strong Veterinary Hospital to perform the procedure(s) listed above and/or on the estimate for my animal. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian.
I have been informed that a routine Dental Prophylactic procedure consists of removal of tartar(calculus), scaling the surface of each tooth, polishing the teeth. A comprehensive oral examination under anesthesia may detect further periodontal disease problems by measuring for pockets, and dental calculus hiding underlying cavities or fractures. When any of a pet’s teeth cannot be treated or repaired to a healthy, comfortable, and functional condition, the normal procedure is removal(extraction) of these teeth. I understand that generally the amount of damage to pet’s teeth varies from minor to extreme, and usually cannot be evaluated accurately until the pet is under anesthesia and the teeth are clean.
I have read and understand this form and accept responsibility for payment of all charges incurred and services provided to my animal by Strong Veterinary Hospital.
29212 Five Mile Road,Livonia, MI 48154
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