Telemedicine Consent Form

Tamarack Veterinary Clinic and its Veterinarians and Technicians wish to consult with you regarding your pet’s medical status following an initial exam or procedure in clinic. Telemedicine is the delivery of health care services using email, text messaging, interactive audio or video technology, where the patient and the veterinary professional are not in the same physical location. Videos, pictures, and text may be recorded and linked to your pet's medical record during this consult.

Tamarack Veterinary Clinic is accredited by the Alberta Veterinary Medical Association and is located at 2531 17th Street NW, Edmonton, AB, T6T 0Y2. We cannot provide services to clients/patients outside of Alberta, Canada. Please call 780-250-1700 with further questions or concerns.
Client (Owner) Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Pet's Name*
Please fill out one form for each patient.
Breed*
Color*
Age*
Please specify weeks/months/years*
- Weeks
- Months
- Years
Sex*
- Male
- Neutered Male
- Female
- Spayed Female
Acknowledgement*
By checking this box I am confirming that I am of legal age and responsible for the pet described above. I understand that Tamarack Veterinary Clinic wishes to have a telemedicine consultation with you and your pet.
Confirmation of VCPR*
PRIOR TO USING THESE SERVICES YOU ASSERT THAT A VETERINARY-CLIENT-PATIENT-RELATIONSHIP (VCPR) EXISTS WITH TAMARACK VETERINARY CLINIC AND THE PET YOU HAVE CONNECTED OR, IN THE ABSENCE OF VCPR, YOU ARE ONLY SEEKING VETERINARY ADVICE AND NOT A DIAGNOSIS, TREATMENT, OR PRESCRIPTION MEDICATION.
Consent*
- As with any online health service, there are potential risks associated with use. When using this service, you understand these additional risks of telemedicine and waive any liability to Tamarack Veterinary Clinic and its Veterinarians and employees.
- I do not consent to the additional risks of telemedicine
Consent*
- These risks include but may not be limited to: Information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate health care decision making by the Veterinarian or Veterinary Technician. Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties. Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information. Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings. Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Veterinarian or the client.
- I do not consent to the above listed risks
Consent*
- Delays in evaluation or treatment could occur due to failures of the electronic equipment or clinic staffing lack of access to all of your health records may result in adverse drug interactions or allergic reactions or other judgment errors; an incomplete or inaccurate diagnosis of pe
- I do not consent to risks associated with delays in evaluation or treatment
Consent*
- I understand I may be required to schedule an in-clinic visit if it is felt that the information obtained via telemedicine was not sufficient to make a diagnosis.
- I do not consent to an in-clinic visit if necessary
Consent*
- If your pet is experiencing an emergency, you should visit an emergency animal hospital immediately. TELEMEDICINE will not be used for an Emergency condition
- telemedicine emergency: I do not consent
Consent*
- By accepting these Terms of Use, you acknowledge that you understand and agree with the following: you may expect the anticipated benefits from the use of telemedicine, but that no results can be guaranteed or assured. Withdrawal of consent may occur at any time and must be submitted by email or written communication to the Veterinarian.
- I do not consent to these terms of use
Consent*
- You understand if seeking A DIAGNOSIS, TREATMENT, OR PRESCRIPTION MEDICATION by Virutal Consultation, your pet must have been seen by one of our veterinarians within the previous 12 months prior to the scheduled consult.
- I do not understand these requirements
Do you have pet insurance, if so, what company?
Please list the policy number.
Signature*
Date*
Date Format: MM slash DD slash YYYY
Best phone number to contact you during the time of appointment*

Have a Question? Need to book an appointment?

Connect with us and one of our team members will be happy to assist you.

CONTACT

2531 – 17th Street NW
Edmonton, AB
T6T 0Y2

Phone: 780-250-1700
Fax: 780-250-1705
Email: info@tamarackvet.com

HOURS

Monday-Friday 8am – 6pm

Closed 12pm-1pm for lunch

Closed Weekends and Holidays

Telemedicine Consent Form

Have a Question? Need to book an appointment?

Connect with us and one of our team members will be happy to assist you.

CONTACT

2531 – 17th Street NW
Edmonton, AB
T6T 0Y2

Phone: 780-250-1700
Fax: 780-250-1705
Email: info@tamarackvet.com

HOURS

EMERGENCIES

For after-hours please contact either:

Boreal Veterinary Centre
13940 164 St NW, Edmonton, AB T5V 0C8
780-306-4400

Pulse Veterinary Specialists and Emergency
320-450 Ordze Rd Sherwood Park, AB
(780)-570-9999

VCA Guardian Veterinary Emergency and Specialist Centre
5620 99 St NW, Edmonton, AB T6E 1V2
(780) 436-5880

Contact Us

Telemedicine Consent Form

Have a Question? Need to book an appointment?

Connect with us and one of our team members will be happy to assist you.

CONTACT

2531 – 17th Street NW Edmonton, AB T6T 0Y2

Phone: 780-250-1700 Fax: 780-250-1705 Email: info@tamarackvet.com

HOURS

EMERGENCIES

For after-hours please contact either:

Boreal Veterinary Centre 13940 164 St NW, Edmonton, AB T5V 0C8 780-306-4400

Pulse Veterinary Specialists and Emergency 320-450 Ordze Rd Sherwood Park, AB (780)-570-9999

VCA Guardian Veterinary Emergency and Specialist Centre 5620 99 St NW, Edmonton, AB T6E 1V2 (780) 436-5880

Contact Us

2531 – 17th Street NW
Edmonton, AB
T6T 0Y2

Phone: 780-250-1700
Fax: 780-250-1705
Email: info@tamarackvet.com

Boreal Veterinary Centre
13940 164 St NW, Edmonton, AB T5V 0C8
780-306-4400

Pulse Veterinary Specialists and Emergency
320-450 Ordze Rd Sherwood Park, AB
(780)-570-9999

VCA Guardian Veterinary Emergency and Specialist Centre
5620 99 St NW, Edmonton, AB T6E 1V2
(780) 436-5880