Brachycephalic Consent Form | Ox Bottom Animal Hospital

Breed-Specific Surgical Risk Authorization

The purpose of this document is to inform you of the significant risks associated with anesthesia or sedation, and even hospitalization, which are inherent for brachycephalic canines.

Not all of these problems may apply to your dog, but these apply to the brachycephalic syndrome. Additional specific concerns pertaining to your pet will be discussed with you.

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Brachycephalic Consent Form:*

Name of Pet:*

The purpose of this document is to inform you of the significant risks associated with anesthesia or sedation, and even hospitalization, which are inherent for brachycephalic canines. Not all of these problems may apply to your dog, but these apply to the brachycephalic syndrome. Additional specific concerns pertaining to your pet will be discussed with you.

We consider brachycephalic breeds to be a high-risk population. Brachycephalic breeds are those with a short-nose and skull, including the English bulldog, French Bulldog, Boston Terrier, Pug, and Pekingese, among others.

Prior to anesthesia, we recommend thoracic radiographs (chest X-Rays) to evaluate for abnormalities that may change our anesthetic plan and to provide a baseline diagnostic in case of post-operative complications such as aspiration pneumonia. Please mark your preference in regards to this recommendation:

Consent*

I would like to have chest x-rays performed on my pet prior to anesthesia.

I DECLINE chest x-rays prior to anesthesia.

Authorization for Services:*

My signature below confirms that I am the owner, or agent of the owner, of the pet identified above, that I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION, AM AWARE OF THE INHERENT RISKS ASSOCITATED WITH THE BREED, AND GRANT MY CONSENT FOR TREATMENT.

Name:*

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