Avian Home Veterinary Care, PLLC

Jessica L. Grodio, DVM, PhD, DABVP (Avian)

Chat waiver and credit card approval form

Name (First & last name of owner) *

Name and species of pet *

I am requesting (chose one) - all options have same fee listed below *

Required 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 - $90 up to 30 minutes
brief consult for follow-up/medical progress discussion - $65 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 $55 per 20 additional minutes
DO NOT approve of an additional charge of $55 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.

Name