New clinic location coming Spring 2025

Consent for Photo/Video Use Form

We would love to feature your pets online! Allow us to share your pet’s image by completing our consent form below.

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Consent for Photo/Video Use Form

Date *

Owner Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone Number *

Email *

Pet's Name *

Consent

I, the undersigned, hereby consent to the collection and use of my personal images by photography or video recording. I acknowledge these may be used on Vitality Veterinary Services’ social media pages (Facebook, Instagram) and website, as well as in newsletters, pamphlets and other promotional materials.

I understand that no personal information, such as names, will be used in any publications unless my expressed consent is obtained.

I also understand that if I wish to withdraw my consent, I can do so in writing at any time. I must forward my withdrawn consent to vitalityvet2019@gmail.com.

I give this consent voluntarily.

Consent for Use of Personal Information in Publications *

I give permission for Vitality Veterinary Services P.C. Ltd. to use my personal information such as my name and/or my pet’s name in any publications seen fit.
I do not give permission for Vitality Veterinary Services P.C. Ltd. to use personal information such as my name and/or my pet’s name in any publication.

I have read and understand this consent.

Witness

Signature of Witness

Clear Signature

Date

Signature of Owner *

Clear Signature

Date *

Comment

New clinic location coming Spring 2025

Consent for Photo/Video Use Form

Consent for Photo/Video Use Form

Consent

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