Disclaimer Form – MENDIP VETS

Your Name*

Prefix

First

Last

Please enter the name of your current veterinary practice *

Please confirm acceptance of our Cancellation Policy*

I confirm acceptance

See Cancellation Policy here

Please confirm acceptance of our liability waver declaration. *

I confirm acceptance

Please see Liability Declaration here.

Please confirm acceptance of our Data Protection and Cookie Policy. *

I confirm acceptance

Please see Data Protection and Cookie Policy here

Please confirm your current Coronavirus status by checking the boxes below.*

I do not have any symptoms related to COVID-19 (cough, high temperature or loss of taste or smell) or generally feeling unwell

I have not travelled abroad in the last 2 weeks

I have not been in contact with anyone who has had coronavirus-symptoms within the last 7 days

I am not pregnant nor living in a household where someone is or may be pregnant

I am not living with someone with an underlying health condition who requires shielding

Please see Coronavirus Disclaimer here.

Consent for photography/filming. Please tick if you agree/disagree.*

I consent to photography/filming

I do not consent to photography/filming

Please see consent declaration for photography/filming here.

I agree to you contacting me with details of other services you provide. Where relevant you may contact me by, (tick if accepted all that apply, your details will not be shared with third party companies):*

Postal Mail

Telephone

Do not contact me

Please enter your address below.*

Please enter your email address below.*

Please enter your phone number below.*

Are you human?*

This field should be left blank