Form Client General Correspondence

By entering my name in the following box, I hereby agree to give the Veterinary Neurological Center the absolute right and permission to publish, copyright, and use the pictures above of me and/or my pet. I and/or my pet may be included in whole or in part, composite or retouched in character:

In order to ensure you have a backup of your submission, please print and/or email a copy of this form. To print a copy of this form: Prior to submission, click the print function from your browser. To receive a confirmation copy of this form via email: Enter your email address in the Email Address box If you do not receive the confirmation copy shortly after submission, please contact us.