Virtual Onsite Visit Authorization & Information – Practice Certification Dashboard

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Fear Free Practice Certification:

Authorization for Video Assessment

aka the Virtual Onsite Visit (VOSV)

Practice Name*

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Address*

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Postal Code*

1. Authorization for Video Assessment & Acknowledgement of Supplemental VOSV Terms & Conditions

Fear Free Authorization for Video Assessment

I hereby authorize Fear Free, LLC and its employees, agents, and contractors (collectively, “Fear Free”) to observe via live stream video and audio the whole of our veterinary practice in connection with the assessment to become a Fear Free Certified® Practice in lieu of an onsite visit by a Practice Certification Consultant from Fear Free. We acknowledge and agree that Fear Free may take still photos and short video recordings (aka images) to document its assessment of our practice. All such images will become the exclusive property of Fear Free and Fear Free may use and publish images that do not contain clients or patients in any manner it determines.

VOSV Supplemental Terms & Conditions

These VOSV Terms & Conditions are in addition to the Terms & Conditions acknowledged when the application for Fear Free Practice Certification was submitted. Terms & Conditions can be accessed at any time from the Fear Free Pets website or the Practice Certification Dashboard.

1. During the VOSV, patient interactions will commence in areas where patients are comfortable and where Fear Free cameras have been placed, or handheld devices such as tablets or phones are able to connect to WiFi and Zoom. Failure to comply may result in a failed visit.

2. In the event of a failed visit, the practice may be given the option to reschedule a second visit. Rescheduling fees will apply.

3. If opting to use WiFi cameras supplied by Fear Free, you will be required to download an app and create an account in said app. When you create your account, use your Fear Free Team Admin email as your username and FearFree_123 as your password.

4. If opting to use WiFi Cameras supplied by Fear Free, a return shipping label will be provided at the conclusion of the Virtual Onsite Visit.

2. Client Authorization for Video Assessment and Images Terms & Conditions.

During the visit, it shall be the practice’s responsibility to inform clients that video observation is in progress and that still photos and short video recordings may be procured during the visit. If Fear Free would like to use an image or short video that contains either or both a client and patient/pet, written permission from the client will be obtained prior to its use. The practice agrees to assist Fear Free in obtaining said written permission.

I have read and agree to the terms for the Video Assessment.

I have read and agree to the VOSV Supplemental Terms & Conditions.

I have read and agree to the Client Authorization for Video Assessment and Images Terms & Conditions.

By typing my full name and job title in the space below, I herby certify I have read and understand all of the information contained in this form.

Full Name & Job Title:

Signature:

Date & Time

Login Message

Fear Free Practice Certification:

Authorization for Video Assessment

aka the Virtual Onsite Visit (VOSV)

1. Authorization for Video Assessment & Acknowledgement of Supplemental VOSV Terms & Conditions

2. Client Authorization for Video Assessment and Images Terms & Conditions.

By typing my full name and job title in the space below, I herby certify I have read and understand all of the information contained in this form.

Signature:

Updated 2021-Jun-28: replaced signature pad with free form type.Previous version available by request

Your form has been submitted

Login Message

Fear Free Practice Certification: Authorization for Video Assessment

aka the Virtual Onsite Visit (VOSV)

1. Authorization for Video Assessment & Acknowledgement of Supplemental VOSV Terms & Conditions

2. Client Authorization for Video Assessment and Images Terms & Conditions.

By typing my full name and job title in the space below, I herby certify I have read and understand all of the information contained in this form.

Signature:

Updated 2021-Jun-28: replaced signature pad with free form type.Previous version available by request

Your form has been submitted

Fear Free Practice Certification:

Authorization for Video Assessment