Dental Release Form

Anesthesia & Dental Release

Northeast Animal Hospital | Tallahassee, FL

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Anesthesia/Dental Release (2026)

Northeast Animal Hospital | Tallahassee, FL

General Information

Date

Patient Name

Procedure(s)

Best Phone Number

Alt Emergency Number

Pet History Questionnaire

1. Are vaccines current?

2. Known Allergies/Reactions?

3. Current Medications?

4. Did your pet have any food or water this morning?

5. On Heartworm Preventative?

Dental Extraction & Sealant Policy

Your pet is being admitted for a procedure that will require the use of anesthesia today. Our staff will use the safest anesthesia available and your pet will be constantly monitored throughout the procedure. However, regardless of an animal’s age or apparent health status, all anesthetic procedures do carry an element of risk. Before anesthesia, a simple blood test is performed which allows us to check the function of internal organs. Knowing how well these organs are working is vital to the safety of your pet. Your pet will be maintained on I.V. fluids throughout the procedure.

PLEASE INITIAL:

Dental Cleaning & Extraction Policy

Dental cleanings involve a thorough scaling and polishing of all the surfaces of the teeth. Then a sealant is applied (Oravet) to the enamel to help reduce plaque and tartar from adhering to the surface. Oravet Chews and Oravet Gel are recommended after the dental cleaning to help re-apply the sealant.

EXTRACTION POLICY: In some cases, we find too much damage to the teeth to be salvaged and they must be removed to address current infection or abscesses. If there are fractures, loose teeth, or root abscesses, immediate removal is warranted. Not doing so perpetuates pain and infection.

PLEASE INITIAL:

Recommended Safety Measures

Cerenia Injection (Anti-Nausea)

The Cerenia injection is used to prevent post-operative vomiting for 24 hours; also has some pain reducing effects. $33.95 (for under 40 lbs; cost increases based on weight above 40 lbs)

I have read the above and APPROVE the administration of Cerenia during my pets surgery to prevent vomiting and reduce pain.

Therapeutic Laser Therapy

Our Therapeutic Laser is used to reduce inflammation and bring healing factors to the treated area. This is especially beneficial in dental cleanings because it accelerates healing at the gums and reduces pain, The cost for post-op laser therapy is $30.

I have read the above and APPROVE the use of laser therapy during my pet’s surgery to decrease pain and inflammation ($30)

Other Services (Check all that apply)

Regular Nail Trim $14

Nail Trim Back $21.80

Anal Glands $20

Pluck Ear Hair $15

Microchip $42.90

No additional services

** A heartworm test is required if results are not on file within 12 months.

Legal Release & Authorization

I understand that there are risks associated with anesthesia and the procedures set forth above. I have read and understood the information above or have had it explained to my satisfaction. I understand that no guarantee or assurance has been made to me as to the results that may be obtained. I agree to hold Northeast Animal Hospital, its servants and agents from any loss or liability in connection with the above procedure(s). In the event complications arise and I cannot be immediately contacted at the provided phone number(s), the surgeon is directed to make the decision he/she deems best for my pet.

Signature (Typed Full Name)

Northeast Animal Hospital is a locally-owned, private veterinary practice serving Tallahassee, FL, since 1971.

Contact Us

(850) 893-5636

Email Us

northeastanimalhospital@gmail.com

Quick Links

Our Services

Address

1407 Timberlane Rd, Tallahassee, FL 32312

Clinic Hours

Mon-Fri: 7:30 AM - 6:00 PM
Saturday: 9:00 AM - 12:00 PM
Sunday: 4:30 PM - 5:30 PM