BrachycephalicConsent Form

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Brachycephalic Consent Form

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

We consider brachycephalic pets a high-risk population. I grant permission for my pet to undergo general anesthesia, sedation, and/or hospitalization.

I am aware that my pet has physical characteristics that make anesthesia and sedation more challenging and possibly riskier than for the average pet with a longer nose.

I am aware that brachycephalic breeds, such as the English and French Bulldog, Boston Terrier, Pug, Pekingese, and Persian cats have a shortened skull, resulting in a compressed nasal passage and abnormal throat anatomy. The abnormal upper airway anatomy causes increased negative pressure while taking a breath, leading to inflammation, deformation of throat tissues, and obstruction of breathing.

I am aware that if my brachycephalic pet undergoes sedation or general anesthesia, the potential complications include partial or complete airway obstruction during recovery and regurgitation or vomiting which could lead to aspiration pneumonia and/or respiratory distress. I am aware that anesthetizing or sedating a brachycephalic animal for any reason can lead to the development of significant complications as described in this document.

Please answer YES or NO to the following questions:

My pet has demonstrated difficult breathing, exercise intolerance, and/or collapse episodes.(Required)
My pet has demonstrated difficult eating; such as gagging, vomiting, and/or regurgitation.(Required)
My pet is receiving or has recently received a non-steroidal anti-inflammatory drug.(Required)
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