Patient Medical Information
Check any of the oral symptoms noted below:
bad breath loose teeth growths on the gum discolored teeth failure to lose baby teeth reluctance to chew hard items fractured/broken teeth red or bleeding gums other
Check the toys and treats provided:
kongs bones raw hides frisbees rope toys dog biscuits ice cubes tennis balls greenies plush/squeaky nylon toys antlers other
TREATMENT AUTHORIZATION and INFORMATION/PHOTO RELEASE
I hereby authorize the veterinary team of Veterinary Dental Specialists of Missouri to examine, prescribe for, and treat my pet.*
I understand that I will receive a summary of the care provided in order to ensure that my pet's care can be continued without interruption.*
I also understand the identification of a referring veterinarian by me to be my authorization for Veterinary Dental Specialists of Missouri to obtain medical records, as well as release records and information to that veterinarian. Case information, medical images, photos and/or videos of my pet(s) may be used in teaching forums, continuing education, hospital web site, veterinary literature, and the like. I authorize the release of case/patient information for such purposes. Patient confidentiality will be maintained.*
