Patient's Name (Pet)
Reason for visit
Duration of signs
Previous medical history/Allergies
Periodically, JPESC will take photographs of our patients for positive promotional purposes for the clinic that may include images/stories for our website, hard print, and social media sites. By initializing, you authorize us to use your pet's images for such promotion at our discretion.
I consent for any reviews or testimonials for JPESC that I post online to be reshared on the JPESC website and other social media platforms for JPESC marketing purposes.