The following information is optional but may be extremely important in regard to your animal's health.

List or describe any major issues for you or your animal's multi-species "family" in the following areas.

Cancellation fee will apply if not given 24 hours notice (Lg./ $100, Sm./ $25).

Applies to:

All clients of Always Helpful Veterinary Services and participants of any Maximum Horse Power event. My signature below confirms that the conditions of my consent to be video-recorded/photographed have been explained to me, and I understand the following:

• I am not required to be video-recorded/photographed.
• I can withdraw my consent at any time by submitting a written request to the practice manager.
• The recordings are for educational/advertising purposes &/or placed on our website and/or social media Page. My name and image will not be used for any other purpose.
• I will receive no compensation for my consent to participate in the recordings.
• Others will review the recordings/photos as an educational opportunity to improve client and patient care. Identity of you and your animal are to be kept confidential unless you choose to be identified as part of a testimonial.

I relinquish any right to the recordings/photos and understand the DVDs/videotapes/photographs may be copied and used by Always Helpful Veterinary Services &/or Maximum Horse Power, without further permission.

I hereby release Always Helpful Veterinary Services &/or Maximum Horse Power, and any of its associated or affiliated companies, their directors, officers, agents, employees, and customers, and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use.