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TVV Lilburn-Stone Mountain Dental Release Form

 

Contact Information
Dental Cleaning Information and Costs

Your pet is being dropped off for a dental cleaning procedure today, which includes scaling, polishing and fluoride treatment of the teeth. For the safety of your pet and as required with all other anesthetic procedures, a blood profile will be performed prior to the procedure. Please note, however, that there are still potential risks involved with anesthesia. The cost of this blood work is included in the cost of the dental procedure. There are, however, other potential costs that may be incurred today, such as possible tooth extractions, dental x-rays, and/or medications (i.e. antibiotics, pain meds, etc).

 

It is also our policy that your pet be current on all vaccines as well as having had a heartworm test or FELV/FIV test within the last year or have the appropriate records provided if these services were done elsewhere. If your pet’s vaccines are past due or you are unable to provide the appropriate records, we will have to administer the vaccines and/or perform the tests needed for your pet to be able to stay at our facility.  An estimate for the cost of such services can be provided to you at your request.

Authorization

During your pet’s dental procedure, if the veterinarian determines your pet may need one or more teeth extracted, and/or dental x-rays, it may not be feasible to contact you for your authorization beforehand, since your pet will be under anesthesia.  Please review each of the three options below, to let us know how you wish this matter to be handled if it becomes necessary.

Please choose and sign ONLY ONE of the three options listed below.

Option 1

1.  I give authorization to carry through with the veterinarian's recommendations regarding tooth extractions and/or dental x-rays, regardless of the additional costs.

Option 2

2.  If the total fees are going to exceed $550.00, please attempt to contact me in order to go over the additional costs.  If the fees do not  exceed $550.00 (or the estimate already provided to you), I understand I may not by contacted until the procedure(s)  is completed.

3.  I do not give authorization for any extractions, dental x-rays and/or other procedures, even if medically recommended by the veterinarian, without contacting me first.

Other Procedures
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Choose Your Location

Decatur

Location
217 N. McDonough St.,
Decatur, GA 30030
(404) 371-0111

Hours
Open 24 Hours

Lilburn-Stone Mountain

Location
1227 Rockbridge Rd., Ste. 300
Stone Mountain, GA 30087.
(770) 717-1650

Hours
Monday - Friday 7am- 7pm
Saturday: 8am- 6pm
Sunday: 10am- 6pm

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Buckhead

Location
3404 Northside Parkway NW
Atlanta, GA 30327.
(404) 844-4824

Hours
Monday - Friday 7am- 7pm
(Doctors' Hours) 8am - 6pm)
Saturday: 8am- 6pm
Sunday: 10am- 6pm

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