Non-Anesthetic Dental Cleaning Waiver Aloha Pet Dental Care, LLCNon-Anesthetic Dental Cleaning Waiver LIABILITY WAIVER & HOLD HARMLESS AGREEMENT Your Info Pet Owner's Name Email Address Cell Number Pet Info D.O.B or Age Gender Male Female Color Breed Pet Name Name of Veterinarian? When was your pet last seen by a Veterinarian? Does your pet have any health conditions or behavior issues? Yes No If yes please explain: Can pet pictures be posted on social media? Yes No Additional Pets Pet Name D.O.B or Age Gender Male Female Breed Color Additional Pets Pet Name D.O.B or Age Gender Male Female Breed Color Additional Pets Pet Name D.O.B or Age Gender Male Female Breed Color Pet Info Notice Please note that your pet may be wrapped or held during this procedure, which may cause temporary soreness to the neck or could potentially aggravate existing back issues. Should your pet exhibit indications of pain that persists for more than a day please contact your veterinarian. By checking the box below and typing your name you are certifying that you have read and understand the information on this form and furthermore acknowledge your understanding that a non-anesthetic dental exam and cleaning is just one part of a complete dental care plan for your pet and may not be as thorough as an anesthetic dental exam , including cleaning and x-rays. Acceptance I accept these terms. Signed - Print Name Send