LISNER - SX Auth Form

Thank you for trusting Lisner Animal Hospital with Pet Name's care! We understand how important your pet is to you, and we are committed to providing the highest standard of care throughout their surgery. Our team is dedicated to ensuring a safe and successful procedure, and we appreciate the opportunity to be a part of your pet's healthcare journey. Please carefully read the following information and fill out all required fields.

Bloodwork Requirements: Bloodwork is mandatory for all pets undergoing procedures that require general or local anesthesia to assess organ function, clotting ability, anemia, infection, and provide a baseline for future reference. If the pet's bloodwork is older than 3 months, it must be repeated before or on the day of surgery. While bloodwork is recommended for procedures involving sedation, it is not required unless anesthesia is involved. Vaccination Requirements: Dogs: Must be up-to-date on rabies, DHPP (distemper, hepatitis, parvovirus, parainfluenza), and leptospirosis vaccines. Bordetella and canine influenza vaccines are recommended but not required. Cats: Must be up-to-date on rabies and FVRCP (feline viral rhinotracheitis, calicivirus, panleukopenia) vaccines. The feline leukemia vaccine is recommended but not required. The clinic reserves the right to decline surgery for any animal not current on their required vaccinations (within the last 12 months). These protocols help ensure the safety and well-being of your pet during surgery, minimizing risks of complications. FOR SURGICAL CHECK-IN STAFF ONLY: Confirm surgeon with pet's owner during check-in Procedure(s) to be performed

YesNo

FOR SURGICAL CHECK-IN STAFF ONLY: Confirm surgeon with pet's owner during check-inProcedure(s) to be performed:

If your pet is getting spayed or neutered today, would you like to get them microchipped?

YesNo

If your pet is getting spayed or neutered today and has any retained baby teeth, would you like us to remove them today? This can help prevent localized periodontal disease, as retained baby teeth provide an extra spot for plaque and tartar to accumulate. Leaving them in can also cause other dental issues such as overcrowding of the mouth, malocclusion (misaligned bite), and negatively affect the development of the adult teeth.

YesNo

If your pet is having a dental procedure, it is possible that we find a diseased tooth or diseased teeth on their dental x-rays that may need to be extracted. Please check one of the boxes below indicating whether or not you would like the surgeon to give you a call before extracting any teeth. If you would like a call, please keep your phone on and near you. If the call is not returned within 20 minutes, the teeth will be left in place.*

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If your pet is having a mass removal or an amputation performed, would you like us to send a sample to the lab for testing? Please note that it is $297.96 to have the first sample sent out, and $98.00 per additional sample.

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Is your pet eating and drinking normally at home?*

YesNo

Date and time of last meal (if you are filling this form out before the night prior to your pet's procedure, please write what time you plan on giving the last meal on the night before the procedure)*

Is your pet urinating and defecating normally at home?*

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Is your pet currently coughing, sneezing or wheezing, vomiting or having diarrhea?*

YesNo

List of current medications and when the last dose was given*

Would you prefer your pet's recovery medications to be in the form of tablets or liquid?*

Would you like your pet to go home with calming medications for the duration of recovery? These are recommended (but not necessary) - keeping your pet calm for the duration of recovery is important for the healing process.*

Nail trims are a free service while pets are under sedation or anesthesia. Would you like your pet's nails trimmed?*

YesNo

If your pet is due for any additional vaccines besides the ones required for surgery, would you like us to update those today?

YesNo

What is the best contact number to call when your pet is ready for pick up? Would you like to add additional contact numbers? (please list)*

To prevent your pet from licking at their surgical incision during recovery, would you prefer to be sent home with a cone, a surgical suit, or both? If your pet is only having a dental procedure done, these items are not necessary.

What to expect after your pet has surgery

The effects of general anesthesia don’t go away immediately. It can take many hours for these effects to wear off. Your pet might be sleepy or tired for the first 24 to 48 hours after surgery.
Recovery can vary from a few weeks to several months, depending on the type of surgery your pet had. For example, soft tissue surgery might require a few weeks of recovery, while surgery on bones, ligaments, or tendons might require six months.
Your pet had a tube placed in the trachea during anesthesia to administer oxygen and anesthetic gas. This can occasionally cause mild irritation and a slight cough. A mild post-surgical cough will typically diminish over the next few days. If coughing persists or worsens, contact the hospital.
Your pet may lack or lose their appetite temporarily after surgery. In addition to nausea and mild regurgitation, this is a common after-effect of the anesthetic.
Some pets may be high-strung or experience anxiety post-surgery. If this is the case for your pet, your vet may also prescribe anti-anxiety medication or sedatives to help your pet remain calm while they heal.
Your pet may experience loose stool or diarrhea post-surgery. This can be attributed to stress or introducing a new medication. If you are concerned, call us immediately. We can assess your pet's recovery progress, evaluate any changes in their bowel movements, and provide guidance on diet and care.
It is very common for animals to not have a bowel movement for one to three days after surgery and not of concern if they are otherwise comfortable, eating, drinking, and not straining to have a bowel movement. 
Animals can show signs of pain in many ways. Sometimes obvious signs include crying, restlessness, unwillingness to lie down, excessive panting, difficulty getting up, or aggression. Other more subtle signs can be hiding, sitting or lying with their bodies tightly tucked up, or lack of normal grooming (especially in cats).

I, Client Name hereby authorize Lisner Animal Hospital to perform the authorized procedures, operations, placement of an intravenous catheter and associated anesthesia on Pet Name. As with any procedure requiring general and/or local anesthesia, there are certain risks that serious complications or even death may result. To minimize the risk of such occurrences, we mandate baseline bloodwork be performed in order to assure proper organ function, clotting ability, detect anemia or infection, baseline for future reference.

Signature of Owner or Agent*

Date*

Date