As an architect, maybe you have somebody or you are going to try and GC yourself, but that point is not clear in your post.Your question is a worthy intellectual exercise. 

Good things can happen from this, but I must give you one piece of advice that you cannot take for a grain of salt.There are no groups of people that are more notorious for shooting themselves in the foot when it comes to real estate than:A. a group of lawyersB. a group of doctors/medical staffC. a group of teachers/professorsFor some reason, despite their high IQs and whatnot, they get into horrible deals time and time again, and their real estate careers typically last 1 or 2 deals max.This doesn't have to happen as long as you're ultra consercative in all estimations and calculations when landing your first deal.

My question is, if we agree to sell the home on a lease-option at our asking price, what are the potential ramifications if the house doesn't appraise for that when the buyer is ready to exercise their option? 

Offices unless medical tenants are generally on gross or modified gross leases.If tenant is reimbursing some expenses then likely they are only paying for the space they occupy.

My wife was in a similar situation years ago with medical debt, took her several years before she started seeing the light at the end of the trashed-credit-tunnel.

I was paying for my wife's medical school costs, and just couldn't save up for 20% down at the time.

If they can be sued for prescribing the wrong medication, and an ESA is a prescription, then I feel that they should be legally responsible if the tenant is not capable of caring for the animal and the property in tandem.

I also began offering a 25% rebate of my commission to military and other local heroes (teachers, police, medical, etc), both as an incentive and because I was actually feeling guilty about how much money I was making and was looking for a way to give back. 

They have the right, but don't have to exercise the right, to the DOS.

Plan was to lease option tenant for 6-12 months and then give tenant option to exercise right to purchase at agreed upon price.