St. Francis Animal Hospital Telemedicine Consent and Information Form
St. Francis Animal Hospital is able to offer scheduled rechecks, behavior consultations, nutrition consultations and medical triage style appointments via telemedicine. Telemedicine appointments are conducted through the use of a computer, smartphone or tablet and allows our veterinarians to see your pet and perform a visual exam during the appointment. Please be sure your pet is with you during the entire appointment.
During the course of the appointment, the veterinarian may decide that your pet needs an in-person physical examination, treatment, and/or diagnostic testing. Should an in-person appointment occur within a reasonable amount of time thereafter as determined by St. Francis Animal Hospital, a $20 credit will be applied to your invoice at the in-person appointment. *
I, the undersigned, authorize St. Francis Animal Hospital and each veterinary staff member, including Dr. Linsay Barnes, to examine, prescribe and treat my pet via teleconference. I understand that without physically examining my pet or performing diagnostic tests such as bloodwork or radiographs, the veterinarian may not have all of the information needed to provide a full and accurate diagnosis. I understand that the veterinarian is making the best recommendation possible without physically seeing the pet and I shall not hold the veterinarian or St. Francis Animal Hospital responsible if this diagnosis is inaccurate or if my pet does not improve with the recommended treatment. I give permission for St. Francis Animal Hospital to discuss medical information via telephone, email, and online video conferencing, and to record the same. I understand that the laws that protect privacy and confidentiality of medical information also apply to telemedicine. I understand that no information obtained during my telemedicine appointment will be disclosed to third parties without my consent.
I also understand that charges will be paid in full at the time of the appointment per the following Fee Schedule: Initial Telemedicine Consultation (up to 20 minutes) $40.00. Time spent in consultation beyond 20 minutes will be charged at an additional rate of $3.00 per minute.
BY SIGNING BELOW, YOU ACKNOWLEDGE, CONSENT AND AGREE TO THE TERMS, CONDITIONS AND STATEMENTS HEREIN
Background Information for Telemedicine Consultation
Submitted successfully! We look forward to seeing you and your pet virtually soon.