Our Deepest Sympathy

Owner's Consent
I attest that I am the owner or authorized representative of the animal described above. The veterinarian has advised diagnostics, treatments, and/or other services for my pet and I have chosen to decline the items that are listed above. The doctor has explained to me the potential negative results of my decision and they have answered all of my questions. I understand what we have discussed. I release Your Visiting Veterinarian, it's staff, and anyone associated with Your Visiting Veterinarian from any liability, impact, or costs that my decision may result in now and into the future.

Medical Records Note

To help us prepare for your first visit, please provide your pet's previous medical history before his or her appointment. You may email the history to info@visitingvetcare.com or fax it to 740-562-6633.

By signing this form:

I give Your Visiting Veterinarian, LLC permission to do a one-time transfer of my pet's or pets' medical records to the clinic, hospital, or individual listed above by the methods I've selected using the contact information I have provided.

I attest that this information is correct and accurate and I release Your Visiting Veterinarian, LLC from any liability or wrong-doing that may occur from the transfer of my pet's or pets' records.

I acknowledge the following:

My veterinarian has offered me the option of a Telehealth Consult. Telehealth appointments are 30 minute appointments that can be done via a phone call or video call.

I am undertaking this consultation with the understanding that there are limitations to what my veterinarian can deduce about my animal’s condition without a physical examination and/or other detailed investigations best done in person. To minimize the risks of errors of clinical judgement my veterinarian may recommend an in-person exam and/or further diagnostic tests. This will then be up to me to decide if I proceed.

I understand that it is my responsibility to contact my veterinarian and/or bring the pet for an exam at the nearest emergency hospital if my pet’s condition persists or deteriorates unexpectedly.

I understand that payment for my consultation and any medications recommended, agreed to and/or delivered to me will be completed in full on my nominated credit card at the end of this consultation.

I understand that the cost of my Telehealth consultation does NOT include payment for other services, examples of which include but are not limited to such things as medications, supplements, tests, procedures, diagnostics, referrals to specialists, hospital care, etc.

I understand that I am consulting with a veterinary professional employed at Your Visiting Veterinarian LLC who is a licensed Veterinary Practitioner in the state of Ohio. I also confirm that my details including my stated residence in the state of Ohio are correct.

Medical Records Note

To help us prepare for your first visit, please provide your bird's previous medical history before his or her appointment. You may email the history to info@visitingvetcare.com or fax it to 740-562-6633.

Medical Records Note

To help us prepare for your first visit, please provide your dog's previous medical history before his or her appointment. You may email the history to info@visitingvetcare.com or fax it to 740-562-6633.

Medical Records Note

To help us prepare for your first visit, please provide your dog's previous medical history before his or her appointment. You may email the history to info@visitingvetcare.com or fax it to 740-562-6633.