Emergency/Treatment Consent Form

Please complete this form as completely and accurately as possible so we can get to know you and your animal(s) before your visit.

Name *

First

Last

Email *

In the event of a veterinary emergency involving your horse, or your horse is boarding or being cared for by someone in your absence, every effort will be made to contact you regarding your horse’s medical condition. However, sometimes situations occur when you as the owner may not be available and decisions regarding the treatment of your horse need to be made in a timely manner. If this occurs, this form will be used as a GUIDELINE for treatment of your horse. *

I as the owner of the horse(s), do give permission for the veterinarians at Larch Veterinary Services to perform veterinary treatment on the above named horse(s) in my absence.

I can be reached at the following numbers while away: *

In the event I am unreachable, I authorize the following individual(s) to make needed medical decisions on my behalf. *

I Agree

Name of Representative(s): *

Phone Numbers *

I authorize services/care/medications up to a monetary limit of the dollar amount below per horse. I assume full responsibility for payment for all veterinary services rendered. *

I Agree

Dollar amount per horse $: *

I have a credit card on file with Larch Veterinary Services. *

If no, please call the office to place a card on file. This consent form will only be considered valid with a current credit card on file.

My horse is insured. *

If insured, policy information: *

In the event that your horse requires surgery, such as colic, would you want your horse to be referred to a surgical/ referral facility ? *

If surgery is a viable option, do you have a preference where your horse is transported? *

For example, Paton and Martin Veterinary Services, Aldergrove, BC or Moore Equine, Calgary, AB

Prior arrangements must be made by you or your representative for transporting your horse to a referral facility. Name and phone number of hauler: *

If the veterinarians at Larch Veterinary Services determine that your horse cannot be “saved” due to the severity of the medical condition and/or financial restrictions, I hereby: *

DO want them to euthanize my horse for humane reasons.
DO NOT want them to euthanize my horse for humane reasons.

Name *

Signature

Clear Signature

Again, every effort will be made to contact you in the event of an emergency. If you know that you will be out of town, please leave phone numbers where you may be reached with your horse’s caretaker or with Larch Veterinary Services. Additional comments/instructions: *

I authorize this form to be valid for treatment of any/all horses I own presently, and in the future. *

I agree

Name *

Signature

Clear Signature

Date *

Phone

Questions?

Get in touch! We look forward to hearing from you.



Location

Coming Soon!



Contact Information

Phone: (778) 562-5455
Email: larchvetservices@gmail.com

}

Hours

Mon – Sat: 9am-5pm
Sun: Closed
Available for equine emergencies 24/7

Name *

First

Last

Email *

Phone

How can we help you? *

Website

We proudly serve the animals of the Enderby, Armstrong, Sicamous, Salmon Arm, Revelstoke, Vernon, Mara, Grindrod and surrounding communities.