Telemedicine Consent/Owner Release
CONSENT FOR TELEHEALTH CONSULTATION
I have chosen to participate in a telehealth appointment for pet
My veterinary care provider explained to me how the video conferencing technology that will be used to facilitate the consultation will not be the same as bringing my pet into the clinic. This is due to the fact that my pet will not be in the same room as the veterinarian and therefore unable to be evaluated physically.
I understand that a telehealth consultation has potential benefits including easier access to care and the convenience of meeting from the location of my choosing.
I understand there are potential risks to telehealth consultations, including:
- Lack of physical examination may lead to the inability to effectively diagnose, treat, and/or manage conditions.
- There are some circumstances in which we are not able to prescribe medications for telehealth patients without the assistance of a primary care veterinarian.
- There may be technological problems, including interruptions, unauthorized access, and technical difficulties.
- Due to potential risks involved, I understand that my veterinary care provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.
I understand that my pet’s telehealth appointment may be recorded in order to keep a detailed record of the visit.
I have had a direct conversation with my veterinary care provider, during which I had the opportunity to ask questions in regard to this procedure. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand.
I consent to the use of my veterinary care provider’s chosen method of technology to deliver Telehealth services which include but are not limited to Skype, Apple Facetime, and voice-only telephone services to facilitate telehealth appointments.
- I understand that Telehealth is NOT an emergency service and in the event of an emergency, I will contact my primary care veterinarian and/or emergency veterinary service.
- I understand that technology mediums including Skype, Facetime, and telephone services are not responsible for the delivery of any veterinary care, medical advice or treatment.
By signing this form I certify that:
