Telemedicine Informed Consent Form

I authorize Oconee Veterinary Hospital and its licensed veterinarians, Jeff Bangle, DVM, and Jeff Stortz, DVM, to provide veterinary telemedicine services for my pet when deemed medically appropriate.

    Informed Consent for Veterinary Telemedicine

    Please read this information before receiving veterinary care for your animal by telephone, video, photographs, messaging, or other remote communication. Ask us about any part you do not understand.

    Veterinarian providing care Check treating veterinarian

    Practice location: 7530 Macon Highway, Watkinsville, GA 30677

    When remote care is available

    The animal must reside in Georgia when telemedicine is provided. Ordinarily, the veterinarian and animal must have an existing veterinarian-client-patient relationship (VCPR). Georgia law allows a limited exception when no veterinarian or veterinary technician within 50 miles of the animal can perform a physical examination within 24 hours of your request; in that situation, we will ask you to present the animal for an examination as soon as reasonably practical. The veterinarian decides whether remote care is appropriate for the animal and concern.

    Limits and alternatives

    A remote visit cannot replace every in-person examination. We may be unable to examine the animal fully, obtain samples, perform diagnostic tests or procedures, or recognize a condition seen only during a physical exam. Incomplete images, sound, records, or communication can increase the chance of a missed or incorrect diagnosis. We may recommend an in-person visit, testing, referral, or emergency care instead of or after telemedicine.

    Telemedicine is not an emergency service and may not be monitored continuously. If your animal has severe trouble breathing, collapse, uncontrolled bleeding, seizures, or another urgent problem, seek prompt in-person emergency veterinary care. If technology fails, call the hospital at 706-769-7513; urgent care should not wait for a connection to resume.

    Treatment and records

    We will document the encounter and take appropriate precautions to protect client and patient records. A prescription or medication can be provided only when permitted by state and federal law; remote contact alone may not qualify. We will explain recommended care, follow-up, and any charges associated with the visit before providing the service.

    Client acknowledgment

    I have received and read this information, including the identity and license information of the veterinarian listed above and the limitations of veterinary telemedicine. I understand that I may ask questions and seek in-person care. I consent to veterinary telemedicine for the animal identified below when the veterinarian considers it appropriate.

    Client Name:

    Animal Name:

    Client Signature:

    Date: