Initial Aquatic Vet/Client Telehealth Consultation

Initial Aquatic Vet/Client Telehealth Consultation

Please complete this form as fully as possible. The primary objective of an initial telehealth call is to help a client rule-in and rule-out possible problems, and determine if there are solutions that a client can implement, or if the problem/s require further veterinary intervention.
Please Note:

Like all medical information, any information you provide below and during a Telehealth call is kept confidential and will not be shared without your written permission.

By scheduling an initial Telehealth appointment you understand and accept that veterinarians, like physicians, are unable to diagnose or prescribe medications without actually seeing the patient/s. If follow up veterinary intervention is needed and we are unable to accept new cases, we will do our best to refer you to another aquatic veterinarian.

An initial 30 to 45 minute Telehealth call costs $50 and includes one (1) follow up call, if needed. We prefer you to pre-pay for the consultation and will send you a PayPal invoice; however, if you or we are unable to schedule a call in 7 days, or if the call is cancelled, we you will receive a full refund.
Your Name*

First NameLast Name
Address*

Street Address

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CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Today's Date*

MonthDayYear
Date
What species or types of aquatic animals are you seeking veterinary advice for?*
Please describe where the animal are house (e.g., tank/s, pond/s), their dimensions or volume, how water is filtered, number of animals, and any other relevant information.*
In your own words, please briefly describe the issues or problems you need help with, and when they were first noticed*
Please describe any treatments, medications, dosage, date/s administered you have tried, and if they were effective.*
If you have any images or videos of the problems you are encountering that would be informative, please upload them here.

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Please indicate the times you can be available for a 30 to 45 minute Telehealth call (8:00 am to 3:00 pm Central Time) in the next week. We will check our schedule and will e-mail you a confirm for the date and time for your telehealth Zoom or a telephone call - usually in 24 hours.*

Any day Monday-Friday, 8:00 am to 3:00 pmMonday 8:00 am tp 12:00 pmMonday 12:00 to 3:00 pmTuesday 8:00 am tp 12:00 pmTuesday 12:00 to 3:00 pmWednesday 8:00 am tp 12:00 pmWednesday 12:00 to 3:00 pmThursday 8:00 am tp 12:00 pmThursday 12:00 to 3:00 pmFriday 8:00 am tp 12:00 pmFriday 12:00 to 3:00 pmSaturday 8:00 am tp 12:00 pm
By signing below I accept the terms and conditions for a Veterinary Telehealth Consult. *

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Please verify that you are human*
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