"*" indicates required fields

Owners Name*
New or Returning Client?*
Other Interested Party
Primary Care Veterinary Hospital(s)*
Specialty Care Veterinary Hospital(s)*
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Appointment Type?*
Do we have permission to share your pet’s medical records with your primary care veterinarian?*
Can we use the digital images of your pet’s mouth for educational and/or social media purposes?*
Pet Information*
Pet's Name
Canine / Feline
Spayed / Neutered
Current on Rabies vaccine?
Click the "+" icon to add a second pet
Initial, indicating approval

Appointment Cancellation

Due to the nature of our dental practice, we offer a limited number of appointments each day. When you book your appointment, you are holding a space on our calendar that is no longer available to our other patients. In order to be respectful of your fellow patients, please call us immediately if you know you will not be able to make your appointment.

If cancellation is necessary, we require that you call at least 72 hours in advance. Appointments are in high demand, and your advanced notice will allow another patient access to that appointment time.

I understand that payment is due at the time services are rendered. The Veterinarian always performs a thorough gross examination during consultation. There is a fee for this service whether a procedure is performed or not performed/declined. Payment may be made in the form of cash, check, Care Credit, and all major credit cards. I am aware there will be a penalty, up to the maximum allowed by law, for a check returned for any reason. I am responsible for all reasonable debt, expense, service charges and fees, including financial, legal, and by collection services/agencies, necessary in the collection of unpaid debt to AVDS. I further authorize AVDS and its financial institutions and agents to retrieve these funds.

I have read, understood, and verify all information provided by me above.

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