Telemedicine Consent Form

Telemedicine Consent Form

    I acknowledge the following:

    My veterinarian has offered me the option of a Telemedicine Consult. This consultation may take the form of a video conference and will result in my veterinarian making a clinical assessment of my pet from a different location to myself.

    I am undertaking this consultation with the understanding that there are limitations to what my veterinarian can deduce about my animal’s condition without a physical examination and/or other detailed investigations best done in the hospital. To minimize the risks of errors of clinical judgment my veterinarian may recommend that my pet attend the hospital and/or undergo further diagnostic tests. This will then be up to me to decide if I proceed.

    I understand that it is my responsibility to contact my veterinarian and/or attend the hospital (or nearest emergency hospital) if my pet’s condition persists or deteriorates unexpectedly.

    I understand that payment for my consultation will be completed in full on my nominated credit card prior to the virtual examination.

    I understand that the cost of my Telemedicine consultation does NOT include payment for other services, examples of which include but are not limited to such things as medications, surgery, procedures, diagnostics, referrals to specialists, hospital care, etc. If other services are recommended by my veterinarian I understand that they will provide me with a written treatment plan listing these things and their costs.

    I understand that I am consulting with one of the veterinarians at White Haven Veterinary Hospital who is a registered Veterinary Practitioner in the state of Pennsylvania. I also confirm that my details including my stated residence in the state of Pennsylvania are correct.