May 12, 2020May 12, 2020 Chat waiver and credit card approval form Please enable JavaScript in your browser to complete this form.Name (First & last name of owner) *I am 18 years of age or olderName and species of pet *I am requesting (chose one) - all options have same fee listed below *a video call consult (phone with FaceTime capability needed for this)a phone (audio only) consultan email only consultRequired acknowledgements (must check ALL boxes) *I understand that this consult is for general care and general health information only.I understand that the veterinarian will NOT be able to give my pet a definitive diagnosis/prognosis from a video consult/photo. I understand that treatments/medications CANNOT be prescribed based on a video consult/photo alone. A veterinary-client-patient relationship must exist to prescribe medications; the patient must have had recent physical exam with the prescribing veterinarian.I understand that this consult should not be used in place of seeking medical attention for ill animals. I am requesting (chose one) *general consult - $80 up to 30 minutesbrief consult for follow-up/medical progress discussion - $55 up to 20 minutes (for patients seen within last 6 months only - Dr. will let you know if you may select this option)If my consult goes longer than the initial allotted time, I *DO approve of an additional charge of $45 per 20 additional minutesDO NOT approve of an additional charge of $45 per 20 additional minutes (in which case the consult will end at the initial time limit)Dr. Grodio will give you a reminder when the initial consult time is up.WebsiteSubmit