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4Dog Dental Waiver

Thank you for making an appointment with 4Dog!

We would like to keep your Dog’s information in our records.

Date of Appointment

Owner Name

Phone

Address

E-mail

"By providing your email you permit 4Dog to send you 1 follow up email and 1 reminder email at your desired interval for your dog's next teeth cleaning. Your email will not be shared with any 3rd parties"

I authorize 4Dog to take photos and videos of my dog to post on their social media.

I would like to be tagged in pictures of my dog on social media.

Owner Instagram

DOG INFORMATION

Dog Name

Gender

Female

Male

Age

Health Issues:

Spayed/Neutered

Yes

HISTORY

Last dental cleaning:

Last vet visit:

your dog under any medication ?

Yes

Explain:

Last rabies date

Has your dog ever bitten anyone? Please provide detail:

How did you hear about 4Dog?

Anything else we should know about your dog?

All animals (in particular older ones) can have unknown underlying health issues and there are always risks involved while working with animals as they can be unpredictable. 4 Dog Dental will take every precaution when handling your pet to do our very best to keep them safe while they are in our care. Your pets’ well being is extremely important to us. I acknowledge that there are inherent risks to my pet in the performance of these services, including, but not limited to cuts, abrasions, infections, allergic reactions, muscle sprains or strains, or adverse reactions due to stress or undiagnosed health/dental issues. I understand and acknowledge that the representatives of 4Dog are not veterinarians and will not perform any veterinary medicine. I understand that sedation free cleanings are a hygienic service and not meant to replace visits to a veterinarian or any veterinary dental service of any kind. I understand that any information provided by the 4 Dog team members should be provided to my vet for follow up inspection. Without advising my veterinarian about performing this dental cleaning, I understand that it may make it more difficult for them to recognize areas of concern in my dogs’ mouth. I have been informed that my dog could potentially have dental issues that should be seen by a veterinarian. I have been informed that a sedation free cleaning may not be sufficient for my dog to maintain their oral health. I understand that there are limitations to sedation free cleanings, including the lack of any diagnosis or treatment. I have chosen to continue with a sedation free cleaning, which may leave underlying dental issues unresolved. I agree that the services provided 4 Dog are provided solely at my risk, and hereby waive and release 4Dog, its directors, officers, employees, shareholders, volunteers, representatives, agents and the host business and its employees and representatives (the “Released Parties”) and indemnify and hold the Released Parties harmless from and against any and all liabilities, claims, demands, causes of action, judgments, costs or expenses (including legal expenses) which 4Dog or the Released Parties may suffer, sustain or incur as a result of any act or omission of any nature or kind whatsoever arising out of, or in the course of the performance of the Services. I agree to all stated in this document and understand that in absence of a signature this will act as my approval to proceed with services.

I understand that it may make it more difficult for them to recognize areas of concern in my dogs’ mouth. I have been informed that my dog could potentially have dental issues that should be seen by a veterinarian. I have been informed that a sedation free cleaning may not be sufficient for my dog to maintain their oral health. I understand that there are limitations to sedation free cleanings, including the lack of any diagnosis or treatment. I have chosen to continue with a sedation free cleaning, which may leave underlying dental issues unresolved.

I agree that the services provided 4 Dog are provided solely at my risk, and hereby waive and release 4Dog, its directors, officers, employees, shareholders, volunteers, representatives, agents and the host business and its employees and representatives (the “Released Parties”) and indemnify and hold the Released Parties harmless from and against any and all liabilities, claims, demands, causes of action, judgments, costs or expenses (including legal expenses) which 4Dog or the Released Parties may suffer, sustain or incur as a result of any act or omission of any nature or kind whatsoever arising out of, or in the course of the performance of the Services.

I agree to all stated in this document and understand that in absence of a signature this will act as my approval to proceed with services.

Date

Signature :

Thanks for filling out our form!