Consent Form Please read and sign the consent form below. Consent Form A virtual VCPR requires documented consent to a telemedicine visit from the client to the veterinarian, including acknowledgment that: The same standards of care under the state veterinary practice act and regulations apply to telemedicine and in-person medical services. The client has the option to choose an in-person visit rather than telemedicine service. Subject to FDA regulations and AMDUCA provisions regarding extra label drugs, veterinarians should give careful consideration to prescribing any medications, especially antimicrobials, but they may prescribe after establishing a virtual VCPR based upon their professional judgment with the following conditions. Prescriptions based on a virtual VCPR should be issued initially for no more than 30 days, and may not be renewed for more than 30 days without an additional virtual or in-person examination. A prescription renewed once and based upon only virtual examinations may not be renewed again without an in-person examination. An in-person examination is required for controlled substance prescriptions, except for limited dosage deemed essential by the veterinarian to maintain an animal’s safety during transport to a clinic for in-person examination. Name * Name First First Last Last Email * Signature * signature keyboard Clear Date Captcha Submit If you are human, leave this field blank.
