Release of Information for Media or Website Publication Your pet is a star and you know it! We know it! Let us share it! Desert Veterinary Medical Specialists would love to share your pet’s story and educate you, your friends, your family, and the community about our company, the conditions that we diagnose, treat, and conquer. We would like you to give us permission to release portions of your pet’s medical history, personal recollections, radiographs, photographs, videotape images, and to use photographs or copies of letters, cards, or other gifts. Your pet’s information and photos may be used on a television or radio program, in print media, educational lectures, on a brochure or on the website and all social media outlets of Desert Veterinary Medical Specialists and or Arizona Veterinary Specialty Center for public education and marketing purposes. We hope that you will follow us on our social media sites and post pictures and stories of your own.Consent*Yes, Share My Pet's StoryNo, Don't Share My Pet's StoryI, the undersigned, authorize the use of my pet’s information as outlined above.I, the undersigned, wish to remain private and do not authorize the use of my pet’s information and decline.Signature*(Owners Signature)Date* Date Format: MM slash DD slash YYYY Owners Name*Pet’s Name*Species*Breed*I am over 21 years of age.*YesNoWe also would like to be able to communicate with you via email. If you would like to receive information from us, please let us know the best email address to use.