Species: CanineFeline
Sex —Please choose an option—MaleMale NeuteredFemaleFemale Spayed
Approximate date of birth
Where you want dental records and discharge information sent
Reason for referring this pet
Has this pet had an anesthetized dental cleaning or treatment procedure at your office? YesNo
If so, when?
Did this patient have dental radiographs taken? YesNo
Previous Treatment and Response
List of Major Medical Problems
Current Medications
Previous Adverse Response to Medications
Previous anesthetic complications or any specific anesthetic concerns?
Please attach relevant medical and dental records, including lab results and dental radiographs. If preanesthetic testing is done prior to referral, please contact our office for recommended testing based on your patient's species, age, and health status. If you need assistance in exporting dental radiographs, please contact our office. Alternatively, records can be emailed to our office at: info@animaldentalnv.com
*Accepted files: .pdf, .doc, .png, .jpg, .gif
Please have your client contact our office at 725-272-3257 to schedule their consultation and/or procedure.
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