I {name} acknowledge the following: 

My veterinarian has offered me the option of a Telemedicine Consult in order to minimise risks to myself and the wider community of the current COVID-19 pandemic. This consultation may take the form of a phone call, facetime call or video conference via platforms such as Google Hangouts, Zoom or other; and will result in my veterinarian making a clinical assessment of my pet from a different location than myself and/or my pet.

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 minimise the risks of errors of clinical judgement my veterinarian may recommend that my pet attend the clinic 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 and any medications recommended, agreed to and/or delivered to me will completed in full on my provided credit card prior to the start of this consultation. 

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 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 written treatment plan listing these things and their costs.

I understand that I am consulting with one of the four veterinarians employed at Poulsbo Marina Veterinary Clinic, who are all registered Veterinarians in the state of Washington. 

I agree to RELEASE OF INFORMATION from Poulsbo Marina Veterinary Clinic to any other health care facility or provider to which my pet’s care may be transferred.