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Step 1 of 3

Primary Owner Name*
***Note: Primary Owner will be displayed as the Name/Number we will contact for anything pertaining to the pets on this account.
Enter First and Last Name
***Please contact your prior clinic and request records be emailed to info@copperpointvet.com PRIOR to first appointment
Co-Owner Name
Address*
Please set your communication preferences by making selections below:
Email
Primary Owner Mobile – Call Me
Work Number
Home Number
Co-Owner Mobile - Call
PHOTO PERMISSION: I hereby grant permission to use any photographs taken of myself or my pet, in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become your property and will not be returned. I hereby authorize to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing your programs or for any other lawful purpose. In addition, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby release rights to all claims, demands, and causes to action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of my estate have or may have by reason of this authorization. In signing this consent, I give authorization to use my name and my pet’s name and information as provided in this New Client Form.*