My pet has demonstrated difficulty breathing, exercise intolerance, and/or collapse episodes.* Yes No My pet snores when he/she sleeps.* Yes No My pet has demonstrated difficulty eating, such as gagging, vomiting, and regurgitation.* Yes No My pet has had airway surgery already.* Yes No My pet has been anesthetized and/or sedated before and had difficulty with anesthetic recovery.* Yes No Name* First Last Email* Please select the SCAN practice you are visiting.* Clearwater Location Naples Location Consent* I have read and understand the above information and give my consent for treatment.Digital Signature* Date* MM slash DD slash YYYY
