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Countryside Veterinary Hospital - Authorization for Surgery & Dental 
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    Pick a Date
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    Post Operative Pain Medication and IV Fluids are Included with every Anesthetic Procedure.

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    To ensure your pet’s health and safety during surgery, we recommend bloodwork to check for liver problems, infections, and other health problems that may be missed with the physical exam.
    • Chem 17, Electrolytes & CBC $143.82
    • PCV/Chem 10 $70.94 (required for patients 8yr and older)
    • No, I decline the additional bloodwork
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    • Yes $16.30
    • No, I decline
    • Yes $12.95
    • No, I decline
    • Yes $1.34
    • No, I decline
    • Yes $78.57
    • No, I decline
    • Yes $47.25
    • No, I decline
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    If your pet is not currently taking any medications, please put "None".
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    Due to the condition of your pet’s teeth, it may be necessary to do further treatments after the dental cleaning is complete. These treatments can include but not limited to Clindoral and Extractions.
    • Yes I give permission for additional treatments to be done while under anesthesia.
    • I would like a call before further treatments.
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    • Go ahead with the recommended procedures.
    • Wake my pet up from anthesia understaning that there will be unsolved medical issues and that there will be additional costs to address these issues at a later date.
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    • Call
    • Text
    • Email
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    Clear
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