Teeth Consent Form

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FDM

Ultrasonic Teeth Cleaning Consent Form

Your Information

First Name

Last Name

Email

Phone Number

About Your Dog

Dog’s Name

Breed

Age

Cleaning my dog’s teeth

I understand Furry Dogmother will be using the Cleany Teeth ultrasound toothbrush on my dog which has no vibration, no movement and no noise.

I consent to the use of a tooth de-scaler on my dog’s teeth in a kind and gentle manner; to remove any loose tartar, plaque or stains from the teeth.

I understand and consent to Furry Dogmother taking before and after pictures to show me and to be displayed on the Furry Dogmother website or social media pages.

I understand that Furry Dogmother will stop the teeth cleaning session and I may need to seek veterinary assistance if:

Any loose teeth are suspectedIf my dog objects and becomes stressed or aggressiveAny 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:

There may be some minor bleeding of the gums during and after teeth cleaning as the tartar and the plaque is removedIf the session must stop for any health or behaviour reasons I will still pay for the full session taking place

Ultrasonic Teeth Cleaning

Whilst this method of dental cleaning is highly effective in removing mild tartar, improving gums and mouth health and breath, Furry Dogmother cannot guarantee the treatments’ effectiveness or suitability for individual dogs due to varying external factors. Furry Dogmother cannot be held responsible for any problems occurring from poor dentition before, during or after any ultrasonic treatments. Furry Dogmother ultrasonic treatment is not a veterinary procedure and Furry Dogmother cannot diagnose any problems with your dog’s mouth.

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 the Furry Dogmother in the future should this be the case.

Data Protection

By ticking the box I consent to The Furry Dogmother keeping my personal details on their database to allow them to contact me if required.

Signature

Typing your name here is in lieu of your written signature.

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