Beaver Meadow Veterinary Clinic
Thank you for taking the time to update your information!
Primary Contact
*
First Name
Last Name
Secondary Contact
First Name
Last Name
Email
example@example.com
Primary Phone Number
*
-
Area Code
Phone Number
Cell Phone Number
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
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Please list the names of the pet(s) you bring to Beaver Meadow Veterinary Clinic (you can add more than one pet per line if necessary):
Emergencies can happen!
We want to make sure we have clear lines of communication with you about the care of your pet. Please make sure to include any person(s)(Secondary Name/Emergency Contact) you give permission to discuss and make medical and financial decisions regarding your pet(s).
Emergency Contact
*
First Name
Last Name
Emergency Phone Number (if Primary Contact cannot be contacted)
-
Area Code
Phone Number
PHOTO/VIDEO RELEASE: I grant Beaver Meadow Veterinary Clinic, the right to take and/or use photographs and/or video of my pet(s) and use their photographs and/or video with or without their name for any lawful purpose including social media, publicity, illustration, or web content. I authorize Beaver Meadow Veterinary Clinic to copyright use and publish photographs and/or video of my pet(s) in hospital and on social media without compensations.
*
I ACCEPT the photo/video release
I DECLINE the photo/video release
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