PLEASE COMPLETE THE FORM BELOW BEFORE TREATMENT. Name* First Last Email* I certify that I am the owner or authorized agent for the owner of the animal.* I certifiyI authorize Dr. Jessica Cantrell to perform treatments on my animal. I have been advised as to the nature of the procedures and the potential risks, and I understand the reason why such treatments are performed, as well as their advantages, and possible complications. I release any liability associated with the treatments performed by Dr. Jessica Cantrell. I also understand that no guarantee of successful treatment can be made.* I authorizeAuthorization is valid for one year from the date of the signature.I authorize Dr. Jessica Cantrell to share photos, videos, testimonials, stories, or general information about my pet on her website or social media accounts.* I authorize I do not authorizeAuthorization is valid for one year from the date of the signature.Digital Signature*Today's Date* PhoneThis field is for validation purposes and should be left unchanged.