Nutrition Consult Request for Veterinarians

As the undersigned veterinarian, I hereby provide consent for a telemedicine consultation with a board-certified veterinary nutritionist, in collaboration with a resident, as part of the veterinary care provided for the above-mentioned patient. The veterinary nutrition specialist may offer nutritional expertise and recommendations to enhance the overall care plan.

Purpose: The objective of this telemedicine consultation is to leverage the expertise of a board-certified veterinary nutritionist to optimize nutritional management for the patient.

Veterinarian-Client-Patient Relationship (VCPR): I affirm that I uphold the VCPR with the patient and owner, and I am responsible for overseeing the patient's medical care.

Telemedicine Consultation: Our board-certified veterinary nutritionist and/or resident can offer remote nutritional recommendations, advice, and guidance to enhance the overall veterinary care of your patient. These recommendations will be communicated to both you (the referring veterinarian) and the client through the nutrition report. We strongly encourage you to review the nutrition report carefully to ensure the comprehensive representation of the patient's medical history and to identify any potential contraindications in the recommendations provided.

Licensing: The board-certified veterinary nutritionist and resident may not be obligated to maintain an active veterinary medical license in the state where I practice or in the state where the patient or client resides.