Neurology Release Form

Release form for a Neurology consult, Neurodiagnostic and/or Neurosurgery
Providing Small Animal Neurological Services

I understand and acknowledge that while Dr. Antonio L. Bowens completed a fellowship and is residency-trained in veterinary neurology & neurosurgery and has been practicing veterinary neurology since 2008, Dr. Antonio L. Bowens is not a board-certified veterinary neurologist as such is designated under the standards set by the American Veterinary Medical Association. I also acknowledge that the clinic has presented me with the option to be referred to a board-certified veterinary neurologist.

Please note the following, if gas anesthesia and neuro-diagnostics (i.e., CT scan, MRI scan, spinal tap, a myelogram, etc.) are recommended for your pet:

*** This facility does have an on-site MRI machine. The advantage of an MRI over a Myelogram/CT scan of spine/spinal cord or a CT scan with iv contrast of the brain/spine/spinal cord has been discussed with me (the client/pet owner). I understand that MRI is considered the gold standard for diagnosis for dogs or cats that have neurological problems, affecting either the brain, spinal cord, or peripheral nerves. I (the client/pet owner) give Dr. Bowens and the staff, here at the Animal Emergency Hospital full consent to move forward with the aforementioned Neurodiagnostic/Neurosurgical procedure. ***

I fully understand that there are potentially life-threatening risks, if I elect to have my pet undergo anesthesia, a spinal tap, any neuro-diagnostics, or a neurosurgical procedure (including paralysis and death involved with the recommended neurological procedure). I (the client/pet owner) realize that no guarantees nor warranty can be made regarding the results or cure for my pet.

By signing below, I acknowledge that I have read and understand the information stated above.