Background/IntroductionVirtual appointments have been considered in our department for many years, as a strategy to lower carbon emissions. The advent of COVID-19 prompted urgent implementation as in person appointments were limited.We performed a prospective audit to assess the effectiveness of this approach in lowering carbon footprint.MethodAudit study of all surgical clinic appointments from 18/03/20–31/03/21at the Upper River Valley Hospital, New Brunswick. Mileage calculated based on a round trip from patient postcode to hospital address.CO2 / CO2 equivalents (CO2-e) emitted calculated from previously published data - mobile phone CO2-e; 0.0092751142 g/minute, laptop; 0.269216134 g/minute, standard car emissions 128.002 g/km.Results were analysed statistically.ResultsType of appointmentTotal Number of patientsNew patientsMale:FemaleMean Distance from Hospital (range/km)Total CO2-e / kgMean CO2-e per patient / kg (range)Median CO2-e per patient / kgVirtual6121621:1.340.06 (6.6–566)0.162.5xE-4 (9.27 xE-5 -0.61)9.3xE-5In Person2661291:1.238.80 (6.6–546)2617.419.9 (0.84–69.89)6.6p-value* 0.600.567 <0.0001 * unpaired t test and chi squared.DiscussionImplementation of virtual appointments significantly lowered the carbon footprint of our surgery clinic. This has the potential to be a positive development in the efforts against climate change. Factors such as quality assurance, patient and physician satisfaction need to be determined however.