Clinic Data Collection & Consent Form

Your Sponsor Partner Information

Authorised Third Party Business Name: Arrovet

Arrovet Representative *

Consent to share information with suppliers

By clicking "I Accept", you consent to VetIQ accessing your Practice Management Software (PMS) data for operational purposes, where VetIQ acts as a service provider processing personal information solely to provide services to the Practice. *

Additionally, you acknowledge and permit VetIQ to process de-identified and aggregated data for analytical purposes and share this anonymised data with authorised third parties named herein for industry analysis, research, and product development, with the understanding that no personally identifiable information will ever be shared with these third parties and that this consent can be modified at any time through the Profile Settings. See Full Terms & Conditions. *

Practice Software *

Clinic Integration Enrolment Form

Integration Partner Information

Partner Business Name: Curious Cat Pty Ltd

Partner Contact: Mike da Gama

Partner Application/Program: VetIQ

Practice Information

Practice Name *

Practice Address *

Practice Phone *

Practice Email *

Clinic Contact (Clinic’s Owner and/or Practice Manager)

First Name *

Last Name *

Title *

Phone Number *

Email Address *

Practice Requirements

Current (installed) version of *

Version

By signing this form, I represent and warrant that I am the Practice’s Owner and/or Practice Manager. I acknowledge and agree that it is the responsibility of the Integration Partner to obtain any necessary consents from the Practice in order to use Practice Data for the purpose of providing the Integration Partner’s integration and connectivity to the Practice. The PMS Provider shall have no liability whatsoever with respect to the use of Practice Data by the Integration Partner. *

By selecting this option, I hereby authorise the Covetrus team to execute the no-fee quote for the integration setup on my account on my behalf. *

Signature *

Clear

Date *

Please return completed form to customersuccessapac@covetrus.com

For security please complete the check below *