Social Media Consent Form

Name(Required)

First Last

Phone(Required)

Email(Required)

Pet's Name(Required)

I hereby give Quebec Highlands Animal Clinic permission to take photographs and videos of myself and my pet for the purpose of posting on Quebec Highlands Animal Clinic’s Facebook, Instagram and clinic website. I hereby release and discharge Quebec Highlands Animal Clinic from any and all claims arising out of use of the photos.

In signing this consent, I give authorization to Quebec Highlands Animal Clinic to use: (Check One)(Required)

Only my pet’s name(s)

My pet’s name(s) and my last name

My pet’s name(s) and my first name and last name

I object to any sharing of medical information about my pet.

I understand that I can revoke this consent any time in writing and that the use of any media authorized will immediately cease.

Signature(Required)

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Social Media Consent Form

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