Please Allow 48 Hours for All Prescription Refills

Media Consent Form

Thank you for choosing Northwest Animal Hospital! Please fill out the form as completely and accurately as possible.

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Client Name *

First

Last

Pet Name *

Species/Breed *

Date *

Email *

I authorize Northwest Animal Hospital to photograph and/or video record my pet during veterinary care. *

I authorize Northwest Animal Hospital to use photographs and/or videos of my pet for:

Northwest Animal Hospital may use secure Al-assisted audio recording during appointments to help create accurate medical records.

I understand:

Acknowledgment *

I certify that I am the owner or authorized agent of the pet listed above and voluntarily grant the permissions, I have selected.

Client Signature *

Clear Signature

Name *

Date *