Telemedicine Consult Request

Telemedicine Consult Request

Please note, you must be an existing client with a current annual exam for your pet.
Name*

First NameLast Name
Pet’s Name*
Phone Number*
Please enter a valid phone number.
Please describe what your concerns are:*
Please include pictures or video. The more pictures, the better. Please ensure lighting and in focus. *

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When are you hoping to schedule the phone consultation? We will call you to verify the scheduled time.
By signing below you are stating you understand there are limitations to telemedicine and that an in person visit may be required. The fee for the telemedicine consult is $65
Signature*

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