Telemedicine Consultation

By submitting this form, I acknowledge the following:

 

My veterinarian has offered me the option of a Telehealth Consultation. This consultation may take the form of a phone call, Facetime call or video conference via Zoom 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 clinic. To minimize the risks of errors of clinical judgement my veterinarian may recommend that my pet visit Kibby Park Animal Hospital during business hours for a scheduled appointment or to proceed to the nearest veterinary emergency facility 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 clinic (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 this consultation. I acknowledge that other charges recommended to me will need to be authorized in subsequent emails after I receive them from my vet in writing.

 

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

 

I understand that I am consulting with a veterinarian employed by Kibby Park Animal Hospital who is a licensed Veterinary Practitioner in Michigan. I also confirm that my details including my stated residence in the state of Michigan are correct.

 

I agree to RELEASE OF INFORMATION from Kibby Park Animal Hospital to any other health care facility or provider to which my pet’s care may be transferred.