Anesthesia/Dental Consent Form

Name: Lone Mountain Veterinary Hospital
Address: 780 College Parkway, Carson City, NV, 89706, United States
Telephone: 775-883-3136
Price range: $

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Anesthesia/Dental Consent Form

Name *

First

Last

Email *

Owner Phone Number *

Owner Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet Name *

Pet Species *

Canine
Feline
Other

Pet Age *

Pet Breed *

Pet Sex *

Neutered Male
Spayed Female
Male
Female

Pet Weight *

I give my permission for anesthesia/and dental procedure *

Yes, I give my permission
No, I do not give my permission

I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me *

I give my permission for CPR (Cardio Pulmonary Resuscitation) - may incur fees of $250 - $500
No, I DO NOT give my permission for CPR (Cardio Pulmonary Resuscitation

I understand that the attending veterinarian will make every effort to contact me with ADDITIONAL dental treatments and/or extractions not outlined in the original treatment plan. If we are UNABLE to reach you by telephone: *

Yes, I give my permission to proceed with any additional dental treatments/extractions deemed necessary.
No, I do not give my permission for any additional dental treatments/extractions
I give my permission to proceed with any additional dental treatments/extractions over the original estimate

Signature *

Clear Signature

Date *

Phone number at which owner/agent can be reached during surgery *

Exceptional care for the pets of Carson City.

At Lone Mountain Veterinary Hospital, we strive to provide the best care possible to each and every patient. Our team is fun and compassionate. We are experts in our fields. We're here to help when you need us most!

Ready to come see us?

Request your next appointment by calling us directly at 775-883-3136!

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Hours

Mon - Fri: 7:30 am - 5:30 pm
Sat - Sun: Closed

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Anesthesia/Dental Consent Form

Anesthesia/Dental Consent Form

Exceptional care for the pets of Carson City.

Contact Info

Location

Ready to come see us?

Hours