Teeth Cleaning Consent Form

I hereby give my consent from this day forward to the staff of Absolutely Animals to carry out, on my behalf; teeth cleaning of my dog.
Venue: 43B Burnt Ash Hill, London SE12 0AE

Owners Name: Owners Name: First Last
Phone Number:
Todays Date: Todays Date: / DD / MM YYYY
Dogs Name
Dogs Breed
Dogs Age at present time
Cleaning my dogs teeth:

Cleaning my dogs teeth: I understand staff will be using the Cleany Teeth ultrasound toothbrush on my dog which has no vibration, no movement and no noise. I understand staff will take before and after pictures to show me. I understand that tartar, plaque or stains will be removed from the teeth during brushing and that a non sharp plastic tool may be used to aid this process.
I understand that the staff will stop the teeth cleaning session and I may need to seek veterinary assistance if:

I understand that the staff will stop the teeth cleaning session and I may need to seek veterinary assistance if: 1. Any loose teeth are suspected 2. If my dog objects and becomes stressed or aggressive. 3. Any obvious abnormalities are visible or suspected in the mouth such as: A foreign body embedded in the mouth, Oral warts, Oral Injuries or Tumours
I understand that:

I understand that: 1. There may be some minor signs of blood on the gum line during and after teeth cleaning as the tartar and the plaque is removed. 2. If the session has to stop for any health or behaviour reasons, i will still happily pay for the full session taking place
I declare that:

I declare that: I do not know of any medical reason why teeth cleaning cannot be carried out on my dog and I acknowledge that it is my responsibility to inform staff in the future should this be the case. I am aware that the teeth cleaning service is not a substitute for a veterinary inspection and staff are not qualified to diagnose abnormalities or disease.
I consent to all the above and confirm that i am the legal owner/guardian of this dog.
Draw your signature into the box below.

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Full Name

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