Brachycephalic Patient Questionnaire

Save time and complete our brachycephalic patient questionnaire form online, at your convenience. We look forward to seeing you soon!
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Brachycephalic Patient Questionnaire

1) Does your pet experience anxiety around vet visits or novel situations?(Required)
2) Does your pet typically require calming/sedation medications to be seen at the vet?(Required)
3) Does your pet exhibit anxiety when you are not around?(Required)
4) Does your pet snore?(Required)
5) Can you hear your pet breathing from the next room over?(Required)
6) Does your pet struggle to breathe while sleeping?(Required)
7) Does your pet wake up suddenly in distress?(Required)
8) Does your pet have limitations on play or walking activity?(Required)
9) Does your pet experience fainting or collapse episodes?(Required)
10) Has your pet had any upper airway surgery previously?(Required)
11) Does your pet experience vomiting? (active process involving abdominal contractions, retching, and forceful expulsion of stomach contents)(Required)
12) Does your pet experience regurgitation? (passive process where esophageal contents are brought back up without much effort or retching)(Required)
13) Does your pet experience diarrhea or abnormal stool?(Required)
14) Does your pet have difficulty eating food?(Required)
15) Does your pet demonstrate licking or lip-smacking behavior?(Required)
16) Does your pet demonstrate hard swallowing?(Required)
17) Does your pet gag when drinking?(Required)
Client Name(Required)
Client Phone Number(Required)