Informed Consent
PETSPAN HEALTH
INFORMED CONSENT REGARDING USE OF VETERINARY TELEHEALTH SERVICES
PURPOSE
The purpose of this form is to provide you with information about veterinary telehealth and to obtain your informed consent for our providers to perform veterinary telemedicine services or veterinary teletriage (collectively “telehealth”) services for your animal (your “Pet”).
NATURE OF VETERINARY TELEMEDICINE
Veterinary telemedicine involves the use of electronic communications to enable you to share medical information about your Pet with one of our providers at a different location for the purpose of enabling the provider to evaluate, diagnose, consult, and provide treatment for the Pet. Veterinary telemedicine allows our providers to establish a veterinarian-client-patient relationship, much as they would during a traditional face-to-face appointment, and as part of the medical care of your Pet.
VETERINARY ENCOUNTERS
Your veterinary telemedicine encounter with Petspan Health (the “Practice”) will primarily take place through live, synchronous video consultations (Zoom or equivalent), which allow the veterinarian to directly observe your Pet, ask questions, and provide diagnosis and treatment consistent with an in-person visit.
Petspan veterinarians may also use in-app chat messaging to communicate with you for follow-up questions, clarifications, or ongoing support regarding your Pet’s care. While chat communication can help enhance continuity of care, all diagnoses and prescriptions are based on a veterinarian-client-patient relationship established through a live video consultation.
If your encounter with the Practice is limited to veterinary teletriage, the interaction may include review of images, history, or chat communication for the purposes of assessing whether your Pet should be referred to an in-person veterinarian. In such cases, no diagnosis, prognosis, or prescriptions will be provided.
BENEFITS
The benefits of veterinary telemedicine include improved access to veterinary medical services and care, including the expertise of specialists and consultants that may not otherwise be available to you and your Pet. In some circumstances, veterinary telemedicine can increase efficiency in evaluations, diagnoses, consultations, and treatment. The benefits of veterinary teletriage include improved and timely access to veterinary information in potentially urgent situations when your Pet may be experiencing a life-threatening emergency requiring immediate veterinary care.
POTENTIAL RISKS
The potential risks associated with the use of veterinary telehealth can include delays in veterinary medical evaluation and treatment, or in the ability to provide or receive information, due to equipment failures or information transmission deficiencies (such as poor image resolution); breach of privacy of personally identifiable information due to security breaches or failures; and adverse drug interactions, allergic reactions, complications, or other errors with respect to your Pet due to your failure to provide complete medical information or records regarding your Pet. Further, in some situations, veterinary telemedicine is not an appropriate method of care. Your veterinarian may refer you to a local veterinarian if they determine an in-person visit will be in the best interest of your Pet.
INDEMNIFICATION
YOU AGREE TO INDEMNIFY AND HOLD HARMLESS THE PRACTICE, ITS EMPLOYEES, AGENTS, DIRECTORS, AFFILIATES, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FROM AND AGAINST ANY AND ALL LOSS, DAMAGE, EXPENSE, LIABILITY, CLAIM, OR DEMAND WHATSOEVER, ARISING OUT OF OR RELATED TO ANY FAILURE OF TECHNOLOGY OR EQUIPMENT IN CONNECTION WITH THE PROVISION OF VETERINARY TELEMEDICINE, WHETHER OR NOT ANY SUCH LOSS, DAMAGE, EXPENSE, LIABILITY, CLAIM, OR DEMAND ARISES FROM OR RELATES TO THE PRACTICE’S NEGLIGENCE.
ALTERNATIVES
Alternative methods of care may be available to you, such as in-person services for your Pet or care from your primary veterinarian.
FOLLOW-UP CARE; EMERGENCY SITUATIONS
If there is an urgent situation involving your Pet, if your Pet may have had an adverse reaction to treatment, or if a technical failure prevents you from communication with one of our providers through the telehealth platform, you may contact the Practice using the contact information below. If the contacts listed below are unavailable, you must seek care for your Pet at an emergency veterinary facility or other provider equipped to deliver urgent or emergent care for your Pet.
PHARMACY NOTIFICATION
Some prescription medications prescribed for your Pet may also be available at outside pharmacies. At your request, Petspan will send prescriptions to the pharmacy of your choice. If you prefer this option, please provide the name, address, and phone number of your chosen pharmacy, and we will ensure the prescription is sent directly to them.
YOUR PRIVACY RIGHTS
The Practice uses network and software security protocols to protect the confidentiality of your personally identifiable information (including, for example, your personal financial data) and the medical information concerning your Pet. These protocols are designed to safeguard the data and to ensure its integrity against corruption. Personal information that identifies you will not be disclosed to any third party without your consent, except as authorized by law for the purposes of consultation, treatment, payment/billing, and certain administrative purposes, or as otherwise set forth in the Practice’s Privacy Policy.
BOARD COMPLAINTS
If you have any questions or complaints regarding the veterinary care provided, you may contact the veterinary licensing board in your state. Below are the boards for the states in which Petspan currently provides care:
VETERINARY STATE BOARD DIRECTORY
California
- Board: California Veterinary Medical Board
- Phone: (916) 515-5220 | Toll-Free (866) 229-0170
- Address: 1747 N. Market Blvd., Ste. 230, Sacramento, CA 95834-2978
Delaware
- Board: Delaware Board of Veterinary Medicine
- Phone: (302) 744-4500
- Email: customerservice.dpr@delaware.gov
- Address: Cannon Building, Suite 203, 861 Silver Lake Blvd., Dover, DE 19904
District of Columbia (DC)
- Board: DC Board of Veterinary Medicine
- Phone: (877) 672-2174
- Email: dcbov@dc.gov
- Address: 899 North Capitol St. NE, 2nd Fl., Washington, DC 20002
Florida
- Board: Florida Board of Veterinary Medicine (DBPR)
- Phone: (850) 487-1395
- Address: 2601 Blair Stone Rd., Tallahassee, FL 32399
Idaho
- Board: Idaho Board of Veterinary Medicine (DOPL)
- Phone: (208) 334-3233
- Email: hp-licensing@dopl.idaho.gov
- Address: DOPL, P.O. Box 83720, Boise, ID 83720-0063
Indiana
- Board: Indiana Board of Veterinary Medicine
- Phone: (317) 544-2409
- Email: VetBoard@vetboard.in.gov
- Address: 1202 E. 38th St., Discovery Hall, Ste. 100, Indianapolis, IN 46205
Iowa
- Board: Iowa Board of Veterinary Medicine
- Phone: (515) 281-8617
- Address: Iowa Dept. of Agriculture, Animal Industry Division
Kansas
- Board: Kansas Board of Veterinary Examiners
- Phone: (785) 456-8781
- Email: vetboard@ks.gov
- Address: 1003 Lincoln St., P.O. Box 379, Wamego, KS 66547-0379
Louisiana
- Board: Louisiana Board of Veterinary Medicine
- Phone: (225) 925-6620
- Email: admin@lsbvm.org, director@lsbvm.org
- Address: 5825 Florida Blvd., Baton Rouge, LA 70806
Maine
- Board: Maine Board of Veterinary Medicine
- Phone: (207) 624-8620
- Address: 35 State House Station, Augusta, ME 04333-0035
Massachusetts
- Board: Massachusetts Board of Registration in Veterinary Medicine
- Phone: (617) 701-8723
- Email: VetMedBoard@mass.gov
- Address: One Federal St., Suite 600, Boston, MA 02110-2012
Missouri
- Board: Missouri Veterinary Medical Board
- Phone: (573) 751-0031
- Address: 3605 Missouri Blvd., P.O. Box 633, Jefferson City, MO 65102-0633
New Jersey
- Board: NJ State Board of Veterinary Medical Examiners
- Phone: (973) 504-6500
- Email: VeterinaryMed@dca.njoag.gov
- Address: P.O. Box 45020, Newark, NJ 07102 | Deliveries: 124 Halsey St., Newark, NJ 07102
New York
- Board: NYSED Office of the Professions – State Board for Veterinary Medicine
- Phone: (518) 474-3817 ext. 210
- Email: vetmedbd@nysed.gov
- Address: 89 Washington Ave., Albany, NY 12234-1000
Ohio
- Board: Ohio Veterinary Medical Licensing Board
- Phone: (614) 644-5281
- Address: Vern Riffe Center, 77 S. High St., Fl. 16, Columbus, OH 43215
Pennsylvania
- Board: PA State Board of Veterinary Medicine
- Phone: 1-833-DOS-BPOA (1-833-367-2762)
- Email: ST-Veterinary@pa.gov
- Address: P.O. Box 2649, Harrisburg, PA 17105-2649
Rhode Island
- Board: Rhode Island Department of Health – Veterinary Medicine
- Phone: (401) 222-5960
- Email: doh.elicense@health.ri.gov
- Address: DOH Center for Professional Licensing, Providence, RI
Vermont
- Board: Vermont Board of Veterinary Medicine (Office of Professional Regulation)
- Phone: (802) 828-3228
- Email: SOS.OPRLicensing2@vermont.gov
- Address: Office of Professional Regulation, ATTN: Board of Veterinary Medicine, 89 Main St., 3rd Fl., Montpelier, VT 05620-3402
Virginia
- Board: Virginia Board of Veterinary Medicine
- Phone: (804) 597-4133
- Email: vetbd@dhp.virginia.gov
- Address: Perimeter Center, 9960 Mayland Dr., Suite 300, Henrico, VA 23233-1463