• Dentistry Authorization Form

  • We thank you for helping us give you the best service possible by completing this
    form within 24 hours of receiving.

    Please carefully read the following and sign the authorization:

     

  • Dental X-Rays

  • *I understand that if I am unreachable at that time, no further dental services will be performed and my pet will be recovered from anesthesia.  This may result in broken or diseased teeth remaining in my pet and additional costs for the future.

  • Extractions

  • *I understand that if I am unreachable at that time, no further dental services will be performed and my pet will be recovered from anesthesia. This may result in broken or diseased teeth remaining in my pet and additional costs for the future.

  • I have received an estimate for the prescheduled services. My pet has not had any food since last night. I am the owner/agent for the described animal, and I authorize and request the services listed on this form. I understand and accept that when anesthesia is involved, there are always inherent risks, including death. I have indicated any additional services I would like performed and understand that the services I have requested may be in addition to those provided on the estimate. I understand that pain and/or anti-vomiting medication will be provided if deemed reasonable.

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  • CANCELATION POLICY

     While we do understand emergencies and other scheduling conflicts can happen and are sometimes unavoidable, we request a 24-hour notice to change or cancel an appointment. After two missed or canceled appointments without the appropriate 24-hour notice, Carlson Animal Hospital will apply a $50.00 cancellation fee.

    Thank you for completing this questionnaire. If you have any questions please call us 708.383.3606

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