I hereby consent to engaging in telemedicine with a Media City Animal Hospital Provider. I understand that “telemedicine” includes the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications. I understand that telemedicine also involves the communication of my pet’s medical information, both orally and visually, to Media City Animal Hospital. The laws that protect the confidentiality of my personal information also apply to telemedicine. As such, I understand that the information disclosed by me during the course of my consultation is confidential. I understand that there are risks and consequences from telemedicine, including, but not limited to, the possibility, despite reasonable efforts on the part of Media City Animal Hospital, that: the transmission of my pet’s medical information could be disrupted or distorted by technical failures; the transmission of my pet’s medical information could be interrupted by unauthorized persons; and/or the electronic storage of my personal information could be accessed by unauthorized persons. In addition, I understand that telemedicine based services and care are not be as complete as face-to-face services. I also understand that if my Veterinarian believes I would be better served by another form of medical services (e.g. face-to-face services) I will be referred to a Veterinary services provider who can provide such services in my area. Finally, I understand that there are potential risks and benefits associated with any form of veterinary evaluation and treatment, and that despite the efforts of my Veterinarian and Media City Animal Hospital, my pet’s condition may not be improve, and in some cases may even get worse. Therefore, I understand that results cannot be guaranteed or assured. I understand that this visit/encounter does not and should not replace a traditional doctor’s office visit; and therefore, I am proceeding with this tele-evaluation at my own risk and understanding. I also understand that should my pet’s condition be an emergency, I should contact an emergency veterinary hospital or present my pet to Media City Animal Hospital during its normal business hours directly. I understand that omitting medical information or misinforming a Media City Animal Hospital Veterinarian may result in an inaccurate diagnosis and treatment. I have read and understand the information provided above.