I understand that Country Hills Pet Hospital is not my primary doctor. I would like Country Hills Pet Hospital to communicate with my primary doctor on physical therapy performed and recommendations made while at Country Hills Pet Hospital. 
Initial  (Initial)        Please Select YesNo    

I understand that any services other than physical therapy will be performed by my primary doctor.  Initial    (Initial)        Please Select YesNo    

I grant Country Hills Pet Hospital the right to take photographs of my pet. I authorize Country Hills Pet Hospital to use and publish photographs in print and/or electronically. I consent to allow my pet's picture, case study, etc to be used for purposes such as publicity, blogs, and web content.  Initial   (Initial)   Please Select YesNo    

Photo Release

I grant Country Hills Pet Hospital the right to take photographs of my pet. I authorize Country Hills Pet Hospital to use and publish photographs in print and/or electronically. I consent to allow my pet's picture, case study, etc. to be used for purposes such as publicity, blogs, and web content.
Please Select YesNo *        Initial *    (Initial)

I have read and understand the above statements and any questions have been answered to my satisfaction by a staff member. I am the owner of the pet listed and authorize Country Hills Pet Hospital to use this information as needed.
Please Select YesNo *        Initial *    (Initial)