Countryside Vet
217-824-3051
Countryside Vet
Call Us Now
(217) 824-3051
Opening Hours
Mon-Fri 8 am to 5 pm*
Schedule an Appointment
Home
About Us
Staff
Blog
Gallery
New Clients
Privacy Policy
Careers
Associate Veterinarian
Veterinary Assistant/Technician/Receptionist
Externships
Veterinary Student Extern Responsibilities
Externship Information for Veterinary Students
Externship Testimonials
Services
Large Animals
Small Animals
Boarding
Grooming
Equine
Forms
Sister Sites
Hillsboro Advanced Veterinary Care
Scratchpay
After Hours Emergencies
Small Animals
Animal Emergency Clinic of Springfield
Large Animals: UNIVERSITY OF ILLINOIS URBANA-CHAMPAIGN
Appointment
Large Animals
Small Animals
Boarding
Grooming
Equine
Countryside Veterinary Service Anesthesia Consent Form
Date
Owner's Name:
Today's Phone #:
Patient Name:
Patient Weight:
Procedure
Please Check the Following:
Pre-anesthetic blood work highly recommended for the safety of your pet undergoing anesthetic procedure. While your pet may appear healthy, this testing can reveal hidden problems. Additional $95.00-$104.00.
Accept
Decline
Pain Medicine is important following any surgical procedure. Orai pain medication will be sent home with your pet as part of routine post-surgical care. Price varies depending on weight and procedure.
Accept
Decline
Post-Surgical laser treatment has proven to increase the rate of healing and decrease pain. Additional $15.00. Cat Declaws will receive two treatments for $30.00.
Accept
Decline
Pre-Operative anti-nausea injection helps prevent nausea post-op, last for 12 hours. Additional $22.00.
Accept
Decline
IV catheter and fluids are recommended to maintain your pet's blood pressure and decrease anesthetic risk, prevent dehydration, and to aid in recovery, as well as to provide a life-line in the event of an emergency. Additional $40
Accept
Decline
E-collar is recommended to stop patients from licking and chewing on incision sites. CVS will not be held liable for any damage done a patient that declines an E-collar. Additional $15.00.
Accept
Decline
Histopathology on mass removals is helpful in determining whether the mass is malignant or benign. Additional $137
Accept
Decline
**All surgery patients are given an antibiotic & pain injection after surgery $12.00**
*Any animal entering the clinic with fleas will be treated at the owner's expense*
Dogs
Rabies $17.00
DHLP $27.00
Bordetella $24.00
Heartworm Test $30.00
Fecal Float $22.00
Microchip $75.00
Flea Prevention
Heartworm Prevention
Deworm
Additional Services
Clean Teeth $130.00 $145.00
Nail Trim $20.00
Clean Ears $18.00
Express Anal Glands $15.00
Cats
Rabies $17.00
Feline Leukemia $25.00
FRVCP $25.00
Leukemia Test $38.00
Fecal Float $22.00
Microchip $75.00
Flea Prevention
Deworm
Clinic Policy: I understand that during the performance for this procedure, unforeseen conditions may he revealed that necessitate an extension or variance in the procedure(s). I expect Countryside Veterinary Service to use reasonable care and judgment in performing the procedure(s). The nature of the procedure and the risks involved has been explained to me, and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting in the procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding the animal.
By checking this box, I represent that I am electronically signing these documents which will have the same effect as the execution of these documents by a written signature.
I Accept
Skip to content
Open toolbar
Accessibility Tools
Accessibility Tools
Increase Text
Increase Text
Decrease Text
Decrease Text
Grayscale
Grayscale
High Contrast
High Contrast
Negative Contrast
Negative Contrast
Light Background
Light Background
Links Underline
Links Underline
Readable Font
Readable Font
Reset
Reset
