Dental Release Form

Complete our Dental Release Form below before your pet's dental appointment with Lincoln Square Veterinary Hospital. For any questions or additional information, pleae contact our practice: (212) 712-9600

Your pet is being admitted today for a dental cleaning. The basic dental cleaning includes ultrasonic scaling above and below the gumline and polishing of your pet’s teeth.

DENTAL RADIOGRAPHS: X-rays are vital in the evaluation of your pet’s dental health to allow detection of problems below the gumline that cannot be seen during an oral exam, as well as an aid in making treatment strategies and to evaluate treatment outcomes. We perform full oral radiographs in all cases.

Dental radiographs may reveal unexpected disease and necessitate the removal of teeth. Extractions are only performed when there are no viable options to save the tooth. Extractions are performed at the doctor’s discretion.

Please choose one:*

I authorize all medically necessary extractions be performed

If I cannot be contacted by phone, I do not authorize any extractions to be performed

Dental Release Form

Please choose one:*

Type your name below as signature confirmation.*