Please, read the agreement below so you will fully understand the limitations of this procedure, and then sign your name at the bottom.


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Limitations of a non-anesthesia dental cleaning

  1. Without anesthesia, we cannot get dental x-rays and may not be able to diagnose or treat any problems at tooth root level.
  1. When calculus buildup is excessive, we cannot always see loose, chipped, or fractured teeth until the tartar is removed. We may recommend additional care requiring anesthesia if we find a problem. You may occur an additional expense by your veterinarian that will not be a part of our cost or procedure.
  1. If your pet has sensitive areas or becomes too anxious during the non-anesthetic procedure, we will not over-restrain them. For this reason, we may not get 100% of the dental calculus off. This depends on your pets temperament and the condition of their teeth.
  1. After the veterinarian’s exam, you will have the option to continue with the non-anesthesia dental, or you may elect to have an anesthesia dental this time, and follow up with a non-anesthesia dental procedure with us every 6 months afterwards.

By scheduling this appointment, I elect to have Natural Veterinary Services, Inc perform a non-anesthesia dental procedure on my pet. I understand the limitations of this procedure, and will not hold Natural Veterinary Services, its employees, veterinary staff, or participating store liable for any complications associated with this procedure nor for any underlying dental conditions which may require a later anesthetic procedure.



I assume responsibility for all charges incurred for services rendered to the patient. Payment or donations are appreciated at the time services are rendered. I understand there is a $35 service charge for returned checks. I understand that any deposits paid for services will go towards the service on the day scheduled, and are nonrefundable or transferrable. I give my permission for the staff of Natural Veterinary Services, Inc to obtain any medical records that may pertain to my pet(s). These records may be collected from any hospital or clinic that my pet(s) has visited in the past or may visit during my time as a client here, and is not limited to any specific ailment or treatment. I have read and understand the disclaimer AND  limitations ABOVE.

Disclaimer statement: I understand that the FDA has not evaluated the efficacy of Bicom Bioresonance, homeopathic remedies, and natural cures. Many holistic products and services offered are not intended to diagnose, treat, prevent, or cure any disease.

By entering your full name you acknowledge to have read the limitations of non-anesthesia dental cleaning for pets and you agree with this. Entering your full name here will be considered your digital signature.