Consent to Release Information
Client Name
*
First Name
Last Name
I give consent for All Pets Health Center to release/receive information for all of my pets to the following:
Boarding/Grooming Facilities
Any Veterinary Clinics and/or Hospitals
Breeders and/or Rescue organizations
Pet Insurance companies
Other
I grant permission to All Pets Health Center to use images or videos taken of myself and/or my pet(s) for use in digital or printed materials for any lawful purposes that may include advertising, display distribution, marketing materials, website content, and social media.
Yes
No
I authorize the following individuals, not already listed on my account, to act as an agent for my pet's medical care in the event that I am not present.
Share a current photo of your pet!
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By signing below, I certify that I am above the age of eighteen and am the person listed above.
Signature
*
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