Telemedicine Consent Form

The provision of Telemedicine is to help you and your pet is given only by veterinarians located at St. Francis Animal Hospital, who’s licensing is in good standing in the State of Georgia.

In some circumstances, Telemedicine may not be appropriate or sufficient to assist in healthcare of your pet, and we may either refer you to another veterinary facility (such as in an emergency or specialty practice) or we may ask you to bring your pet in for an in-person visit. The choice of when Telemedicine is not appropriate is solely the veterinarian’s decision.

Your consent for Telemedicine will remain valid and on file until:

1. You tell us in writing that you no longer consent to the use of Telemedicine with the veterinarians at St. Francis Animal Hospital.

2. You have not had your pet seen by us in the last 12 months (or had a visit to the premises where your operation or production facility is in the last 12 months)

3. We inform you of additional consent or requirements to continue the use of Telemedicine in writing.

In accordance with Georgia Code 43-50-121 (a) (3), you hereby consent, and your electronic reply shall be deemed an electronic signature, if you respond, “I Consent” and provide the Date of such consent.