Policies, Disclaimer, & Consent Forms

I (type first & last name) blanks* agree I will review all IVS policies below prior to the agreement:

POLICIES:

1. SCHEDULING: IVS is not a full-service practice! We are a part-time, limited-availability service that only offers scheduled appointments to address and treat any illness and/or health concerns. You must have an Initial Consult on file with your pet to be considered a regular patient. Wellness appointments are brief and do not qualify as an Initial Consult visit. All follow-up scheduling, questions, and payments must go thru IVS staff - NOT DR. KEILLOR! IVS will respond as soon as possible, but it is possible you may not get a response for 24-72 hours. 
 
2. WELLNESS EXAMS: We do offer basic Wellness Exams for canines to have vaccines, heartworm testing, titer testing, and other basic wellness services provided prior at the Wellness Clinics. We are legally unable to address any health/medical concerns outside of what we offer for basic wellness services due to the limited exams being offered.
 
2. DEPOSITS: Deposits will be required for ALL appointments, and are refundable only if the 48-hour required notice is given to cancel and/or re-schedule. We honor and respect the time you are paying for our expertise, education, and services. As our availability is so limited, we rely on you to be prepared and on time for your scheduled appointment so we can ensure we are not rushed to address your concerns. Should you arrive late for a scheduled appointment, it is likely you will be asked to re-schedule, and your deposit will be forfeited. It is not fair, nor ethical for us to try and rush through an appointment and possibly overlook or miss key factors pertaining to their treatment. 
 
3. VIRTUAL/PHONE/TEXT APPOINTMENTS-CONVERSATIONS: TIME TO SPEAK WITH DR. K OVER WITH ANY QUESTIONS, CONCERNS, FOLLOW-UPS, NEW SYMPTOMS, ETC. MUST BE REQUESTED AND SCHEDULED LIKE ANY OTHER APPOINTMENT! Your pet MUST have a current in-person physical exam on file in order to request a phone, text, and/or virtual appointment. DR. KEILLOR CAN NOT LEGALLY GIVE ANY TYPE OF MEDICAL ADVICE TO A PATIENT SHE DOES NOT HAVE A CURRENT EXAM ON, NOR HAS NEVER EXAMINED! ATTEMPTING TO CONTACT DR. K DIRECTLY VIA HER PEROSNAL CELL PHONE WILL BE CONSIDERED NON-COMPLIANCE AND WILL RESULT IN ADDITIONAL FEES AND/OR DISMISSAL FROM OUR PRACTICE.

 4. PAYMENTS: Payment is required in full at time of service(s). We accept Visa, Mastercard, Discover, AMEX and debit cards. IVS does not keep cash/change on hand so cash payment is not recommended as change cannot be made. NO checks will be accepted!
 
5. SERVICES: IVS is unable to provide x-rays, dental cleanings, urgent, emergency, and/or surgical services. We always recommend consulting your full-service veterinarian if/when these services are required. When/if applicable, Dr. Keillor may be able to accommodate specific requests like these at another one of the facilities she practices at.

I, (type first & last name) blanks* agree to review IVS disclaimer policy.

DISCLAIMER:

IVS is an integrative practice that utilizes a full spectrum of conventional and complementary modalities to treat each patient. We believe in informed consent and education. In order to best treat your pet(s), please review the following to ensure we are a "good fit" with your and your family's expectations.  

 

1. A number of open published trials of the medical interventions have been conducted showing evidence of efficacy. However, no double-blind crossover trials which represent the standard as far as the medical profession is concerned currently exist for some of our recommended treatments. Although some are unproven in terms of efficacy, these interventions and treatments present minimal risk of harm and are based on scientific research and logic.
 
2. These interventions form a part of the overall individualized plan for an individual patient. it is not a substitute for appropriate education, care, and health management. It entails a lot of patience, determination, reliability, and resiliency from all - the physician, the patient, and the whole family. We depend and rely on you to keep us informed on your pet's progress! You agree to keep us posted on your pet's day-to-day routines and improvements, declines, etc., so we can ensure compliance is met and when/if we need to adjust any therapies and/or plans.
 
3. Although ultimately benefiting from these therapies, many patients may show transient regression (i.e. die-off reaction from anti-fungal meds, yeast, bacteria, etc.) during these treatments. It is not uncommon to see waves of improvement followed by waves of regression, especially within the first 3-12 months (typically dependent on severity and length of illness) of treatment. However, there are methods employed to minimize and manage these reactions if/when they arise.
 
4. At present, it is difficult to determine which patients will benefit from these therapies with great accuracy. Some patients who may be perfect candidates may not have any improvement; while others who seem to have little reason to recommend therapy will show marked improvement. In general, the only way to determine this is to attempt treatment and observe the response.
 
5. Since medicine is a combination of art and science, and each patient's situation includes variables that are unique and at times not fully understood, there is no guarantee that satisfactory results will be achieved.

CONSENT:

 

Please read and sign below to confirm consent for treatment for your pet(s):
I knowingly and willingly give my consent on behalf of myself and my pet(s) for treatment. I have had ample opportunity to discuss the nature, the risks and benefits, anticipated costs, and the reasoning for the treatments. I understand that medical treatment is a constantly evolving art and that the treatment results are not guaranteed or may result in expected and/or unexpected adverse events. While my veterinarian and staff will take all reasonable precautions to ensure me and my pet's safety, I am willing to assume the risks of treatment whether known or unknown. I am seeking treatment in order to further my pet's health and for no other reason. I am aware that IVS retains the right to refuse/discontinue services and treatments at any time based on their discretion.

Acknowledging the above, the fact that there is a sense of urgency in initiating these interventions, and weighing the risks versus the significant potential benefits, I (type your first & last name) ,* give consent to Dr. Genevieve Keillor and her staff to administer recommended biomedical interventions to my pet(s). I will not hold responsible Dr. Genevieve Keillor, Integrative Veterinary Services, any of the practice's staff, or any other person associated with the medical intervention, for any form of injury, physical, behavioral, and/or emotional problems/distress experienced by my pet(s) or myself. I agree to keep IVS up to date on how my pet is doing during treatments including no improvements seen, what improvements are being seen, any side effects noticed, as well as how I am feeling about my pet's health. You also agree to not discontinue any diet, medication, supplement, and/or general treatment plan changes without contacting us first to discuss why you feel it/they are no longer necessary.

By signing below, I am acknowledging I have read and understood the Disclaimer and Informed Consent above, have understood the potential risks and benefits, and agree for my pet(s) to receive treatments, following the standards and principles of conventional, complementary, alternative, holistic, and/or integrative medicine.