Arden Animal Hospital

1823 Fulton Avenue
Sacramento, CA 95825


Dental Release Form

Dear Clients,
Prior to scheduling dental procedures, we will attempt to evaluate the patient's condition as thoroughly as possible and base our estimate accordingly. Unfortunately, some abnormalities such as fractured teeth, cervical line lesions, periodontal pockets and abscesses are not readily apparent, especially when covered by a layer of tartar. Dental radiographs and periodontal probing may reveal conditions needing treatment that was not initially anticipated, and incur additional charges. Because of this, we ask that you make your daytime phone number available to us so that we may phone you during the procedure if additional problems have been found.
In case of the additional/non-emergency procedures that become necessary, I would like you to: (required)

Proceed with any treatment deemed necessary including extractions, x-rays and antibiotics
Proceed with necessary treatment up to a certain dollar amount (chosen below)
Try to phone first, if you cannot reach me on the telephone you may proceed with any procedures deemed necessary
Do nothing unless you reach me by telephone

Proceed with necessary treatment up to $____ additional cost (if this selection was chosen above)

Telephone number(s) I can be reached at between 9am-6pm today: (required)

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