New Patient Form: Dentistry

If your pet has an upcoming Dentistry appointment with Dr. Barden Greenfield, please complete the specialty form using one of the options below.

OPTION 1
Complete Online

Complete and submit the form below.

OPTION 2
Print & Complete

Bring the completed form with you.

Download PDF

OPTION 3
Complete on Arrival

If you prefer, you can complete the form when you get to our hospital.

Dental & Oral History

Please answer the following questions to the best of your knowledge.

Patient Name *

What is the present oral complaint that is affecting your pet? *

Approximately how long has this problem been going on? *

Was this problem either seen or treated by a veterinarian? *

If yes, when was the last oral/dental treatment performed?

If an oral procedure was performed by your family vet, did they perform diagnostic dental x-rays on that day?

Do you routinely do any of the following (Choose all that apply)

Brush pet's teeth

Give pet daily chews

Rinse pet's mouth with approved dental rinses

Has your pet had any past or is experiencing present illnesses? *

Yes

If yes, please list.

Please list any medications your pet is currently taking (i.e. Heartworm prevention, Anti-inflammatory medications (Rimadyl, Previcox, Metacam) , Antibiotics (Clavamox, Antirobe/Clindamycin, thyroid medication, insulin, others)

Has current blood work (wellness scan or pre-anesthetic blood panel) been performed by your family veterinarian within the last three months? *

Who is your family veterinarian? *

Name of Family Veterinary Practice *

Post-Procedure Communication

Dr. Greenfield or Tammy/Rayanna (his technician) would like to communicate with you the next day or so following the procedure. This helps us better follow your pet’s progress to normal dental health.

Pet Owner Name *

Email Address

Phone *

By submitting this form, I agree to the above.

From Happy Pet Owners

“What a wonderful alternative when something happens to your babies outside normal vet hours. They treated us and my kitty like family. Explained everything and fixed him right up. He’s not enjoying the cone, but his stitches look great. Thank you to the whole team!”
Kelly C.