Dental Questionnaire (HVSH) - Metropolitan Veterinary Associates

Company

This field is for validation purposes and should be left unchanged.

Pet Name*

Breed*

Weight*

Please include units (lbs or kg).

Date of Birth*

Species / Type*

What oral signs is your pet experiencing at home, or what did your primary veterinarian refer you to see the dentist for?*

If no, how long has your pet not been eating or drinking?*

If yes, please explain*

If yes, please explain the anesthesia complications*

Date of last CBC/Chemistry*

Full lab work is required within 60 days of the dental consultation or surgery.

Primary veterinarian*

Email address*

Primary contact number*

Signature*

Date*