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503-292-4533
15800 Upper Boones Ferry Rd,
Lake Oswego, OR 97035
Formerly known as Animal Dental Clinic
Advanced Dentistry & Oral Surgery Referral Practice
Home
About
Veterinarians
Staff Pets
Before and After
Advanced Pet
Dental Care
Anesthesia
Board Certified Anesthesiologist
Computed Tomography(CT)
Digital Dental Radiography
Feline Tooth Resorption
Feline Stomatitis
Fractured Teeth and Root Canal Therapy
Jaw Fractures
Oral Tumors
Orthodontics
Periodontal Disease
Professional Dental Cleanings
Prosthodontics and Restorative Dentistry
Tooth Extraction
Vital Pulpotomies
At Home Pet
Dental Care
Client
Center
Online Forms
New Clients
Pet Friendly Hotels
Referring
Veterinarians
Continuing Education
Seminar Schedule and Signup
Out-Patient CT
Contact
Appointment
Oral Emergencies
Home
About
Veterinarians
Staff Pets
Before and After
Advanced Pet
Dental Care
Anesthesia
Board Certified Anesthesiologist
Computed Tomography(CT)
Digital Dental Radiography
Feline Tooth Resorption
Feline Stomatitis
Fractured Teeth and Root Canal Therapy
Jaw Fractures
Oral Tumors
Orthodontics
Periodontal Disease
Professional Dental Cleanings
Prosthodontics and Restorative Dentistry
Tooth Extraction
Vital Pulpotomies
At Home Pet
Dental Care
Client
Center
Online Forms
New Clients
Pet Friendly Hotels
Referring
Veterinarians
Continuing Education
Seminar Schedule and Signup
Out-Patient CT
Contact
Appointment
Oral Emergencies
Medical Authorization and Release
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*
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Please Complete 2 Days Prior To Your Pet's Surgical Procedure
Name
*
First
Last
Phone number where you can be reached today:
*
Additional phone number:
*
Email
*
Pet's Name
*
Does your pet have any food restrictions?
*
YES
NO
If YES was selected, please explain:
*
Is your pet under 15 lbs?
*
YES
NO
If your pet is under 15 lbs, please make a selection:
*
I prefer liquid medication
I prefer tablet medication
Please list all current medications your pet is taking?
I hereby authorize Oregon Veterinary Dental Specialists, and their staff members to administer treatment and perform diagnostic procedures and surgeries that are deemed necessary based on the findings of our evaluation. I consent to the administration of anesthetics and sedatives that are appropriate to perform such procedures.
*
I authorize
I certify that I have read and understand the above authorization. I also certify that no guarantee or assurance has been made as to the results that may be obtained, and that complications may arise from procedures.
*
I do
Hospital Policy: Oregon Veterinary Dental Specialists abides by a veterinary referral Code of Ethics. If your pet has been referred by your veterinarian for treatment by Oregon Veterinary Dental Specialists and requires medical attention unrelated to an oral condition, please contact your primary care veterinarian for further assistance.
*
I understand and I agree
Dental procedures are not always predictable, but when possible we like to work within your afternoon schedule to arrange a pick up time for your pet. Surgical discharges times may vary.
*
I understand and I agree
Your pet will be shaved for IV Catheter and Blood Pressure monitoring.
*
I understand and I agree
Payment: Payment is due at the time of service. We accept Visa, Mastercard, Discover, Care Credit and Debit cards, in addition to checks and cash. I certify that I assume financial responsibility for all charges incurred to this patient and authorize direct payment to Oregon Veterinary Dental Specialists.
I understand and I agree
Credit: The Oregon Veterinary Dental Specialists cannot extend credit.
*
I understand and I agree
I agree to the release of photos, radiograph or testimonials of my pet for Oregon Veterinary Dental Specialists’s use for continuing education, ADC’s website or Facebook page.
*
I ACCEPT
I DECLINE
Signature (Owner/Responsible Party)
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Date
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