Drop Off Questionnaire

, do hereby certify that, at I am the owner (or duly authorized agent for the owner) of the animal described above, and I do hereby give Hallie Ray Moore, DVM, her agents, servants and/or representatives full and complete authority to perform any procedure that, at her discretion, may be useful to promote the health of the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release.
Do we have your permission to perform diagnostic bloodwork on your animal prior to contacting you?
Do we have your permission to perform radiographs (x-rays) on your animal prior to contacting you?
Would you like to have your pet microchipped for an additional charge?
By signing below, I hereby grant Oak Forest Veterinary Hospital permission to take photographs of myself and/or my pet, and to publish those photographs for any lawful purpose, including, but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to use my name and/or my pet’s name.

By signing this document I authorize Oak Forest Veterinary Hospital to edit, alter, share, remix, tweak, build upon or in any way alter the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my or my pet’s image(s) and name(s) for the personal or commercial purposes outlined above.
Accept Terms