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    *Must be at least 18 years of age to complete this form*
  • Patient Information

  • Authorization Treatment / Consent for Surgery

  • I, as owner or agent for the owner of the animal listed above, have the authority to execute this consent. I authorize Countryside Large Animal Veterinary Services, PLLC to treat and/or perform surgery on the animal listed above. This treatment/procedure may include the use of appropriate diagnostics, medications, anesthetics and/or surgical procedures as deemed necessary in the exercise of the veterinarian’s professional judgement.
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  • Surgery Consent Form

  • Pre-Anesthetic Blood Work

    At Countryside Large Animal Veterinary Services, PLLC pre-anesthetic blood work is required and included in the cost estimate of the surgery for all equine patients. Pre-anesthetic blood work screens the liver, kidney, metabolic and bone marrow functions of your animal. This helps to ensure that your animal will be capable of effectively metabolizing the anesthesia we administer, thereby minimizing the likelihood of any unexpected complications. Your animal’s safety is our highest priority and anesthetic regimens can be altered to fit any particular health concern.
  • Provision of Pain Relief

    Administration of pain medication before some procedures may be warranted. The provision of pain relief is not included in the cost of your animal’s surgical procedure estimate. Pain relief medications post-surgical procedure may also, be necessary.
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