Coastal Rivers Pet Hospital
  • Home
  • About
    • About
    • Policies
    • Dr. Borgmann
    • Dr. Taylor
    • Dr. Lawrence
    • Dr. Fritz
    • Dr. de Jong
  • Services
    • Services
    • Surgery Dentistry Radiology Endoscopy
    • Orthopedic Surgery
    • Rehabilitation >
      • Stance Analyzer
      • Therapeutic LASER
      • Underwater Treadmill
      • Regenerative Therapy PRP and BMAC
    • End of Life
  • Contact
    • Contact
    • Book your appointment on line
    • Prescription Renewal Form
    • New Client Form
    • Petly Pages
  • Emergencies
  • New Client Form

Tele-medicine Consent Form

Tele-Medicine Consent Form

Remember to also fill out the Tele-medicine History form
Telemedicine Consultation Consent Form -Available during the COVID-19 Pandemic ONLY
​

To participate in this telemedicine consultation please read each paragraph and initial the paragraph to indicate your understanding and acceptance. Please sign this form, scan or photograph the form, and return it by email to [email protected]

This telemedicine consultation is only available to those that are unable to leave their homes to bring their pet to the veterinary hospital for the following reasons: 
1) You are in quarantine because you have traveled to another country.
2) You are awaiting results of your COVID-19 screening. 
3) You are under quarantine because you have tested positive on COVID-19 screening. 

Initial ________________

This telemedicine consultation is NOT available to the general public who wish to self- quarantine. 
Initial _______________

Telemedicine consultations are limited in their diagnostic ability. It does not and cannot replace a full physical examination performed by a licensed veterinarian. The goal of the consultation is to provide guidance and triage in situations where the owner and pet cannot leave their homes. Without a physical exam and appropriate diagnostic testing there is a risk of missing a diagnosis. 
Initial ________________

I, _________________________________ (Please print your name), would like to proceed with a telemedicine consultation and understand the limitations of such a consultation. 

Signature ____________________________

Click the link below to book an appointment online!
Book Appointment
Take Our Survey
Refer a Friend
See your pet on
Petly – As your pet's personal health page, Petly is a special
place for you and your pet. You're just one click away! – GO
TO PETLY
AAHA Certified
Fear Free  logo
  • Home
  • About
    • About
    • Policies
    • Dr. Borgmann
    • Dr. Taylor
    • Dr. Lawrence
    • Dr. Fritz
    • Dr. de Jong
  • Services
    • Services
    • Surgery Dentistry Radiology Endoscopy
    • Orthopedic Surgery
    • Rehabilitation >
      • Stance Analyzer
      • Therapeutic LASER
      • Underwater Treadmill
      • Regenerative Therapy PRP and BMAC
    • End of Life
  • Contact
    • Contact
    • Book your appointment on line
    • Prescription Renewal Form
    • New Client Form
    • Petly Pages
  • Emergencies
  • New Client Form