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Telemedicine Informed Consent Form

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Telemedicine Informed Consent Form

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I authorize Fairview Animal Hospital and its licensed veterinarians, Dr. Andrew McKnight, Dr. Janet Morley, Dr. Deborah Martin, and Dr. Chandler Watson, to provide veterinary telemedicine services for my pet when deemed medically appropriate.
- Telemedicine may include consultation, follow-up care, review of diagnostic results, medical advice, and communication by telephone, text message, email, or other electronic means. - Telemedicine has limitations because a hands-on physical examination cannot always be performed. - The attending veterinarian will determine whether telemedicine is appropriate. If it is not, I may be instructed to schedule an in-person examination, seek emergency care, or obtain specialty care. - Communications, photographs, videos, emails, and text messages related to my pet's care may become part of the permanent medical record. - Telemedicine does not guarantee a diagnosis, treatment plan, or successful outcome, and applicable examination or consultation fees may apply. - All telemedicine services are provided by veterinarians licensed in the State of Georgia.(Required)
This consent remains in effect until I revoke it in writing, my pet has not been examined by Fairview Animal Hospital within the previous twelve (12) months, Fairview Animal Hospital requires updated consent, or applicable law requires a new authorization.
By signing below, I acknowledge that I have read and understand this consent, have had the opportunity to ask questions, and voluntarily consent to receive veterinary telemedicine services from Fairview Animal Hospital. I understand that this authorization may include electronic communications and electronic signatures as permitted under O.C.G.A. § 43-50-121 and other applicable Georgia law.
Acknowledgment(Required)
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