Declaration of Informed Consent

I, the undersigned, being 18 years of age or older, am the owner or authorized representative of the owner of the animal(s) described above and am authorized to make decisions regarding its/their care.

I understand the potential benefits of using telemedicine consultation for my pet(s) as well as the potential risks of a treatment and/or procedure recommended based on telemedicine consulting, as a thorough physical examination may not be possible at all times using this mode of medical management and treatment for my pet(s). Limitations of telemedicine include inability to see the pet in person first-hand, inability to palpate skin, ears and other body organs, inability to perform diagnostic tests that may usually be undertaken, and raises possible risks related to assessments and treatment decisions in case there is insufficient information available or provided to the vet-erinarian and/or veterinary team. While risks of misdiagnosis and inappropriate treatment deci-sions resulting from incomplete information are higher with telemedicine, I understand that treatment decisions will be made with best available resources, including need for a possible in-clinic assessment directed by the veterinarian whenever deemed necessary. There exist poten-tial risks of health and outcome if a telemedicine consultation was obtained without following up on the treatments and/or diagnostic tests advised during the consultation.

I consent to obtaining telemedicine veterinary dermatology consultation(s) and am aware that this method of consultation is not identical to an in-clinic patient visit for physical examination of my pet, including follow up or recheck consultations.

I assume complete financial responsibility associated with costs of travel, medications, treat-ments, diagnostics, and additional evaluations (in person or via telemedicine) inclusive, outside of the cost of the telemedicine consultation. Informed consent is an ongoing process that requires continued discussion and consultation between the client and a veterinarian; and I may withdraw my consent for further care or treatment at any time I feel necessary. I will be responsible for payment of services I have obtained until the time of such consent withdrawal.

I have read and understand the information on this form. The information on this form has been explained to me. My questions have been answered. I declare that I provide my consent to the above-noted product(s)/procedure(s) (inclusive of drug therapy).