Certified Urgent Care Logo Release Form
Please complete the Certified Urgent Care Logo submission form.  You will be contacted by a UCAOA staff member upon approval or notified if further information is needed.  Once your materials are approved, you will receive the logo files via email.  Questions? Please email certification@ucaoa.org .

500 of 500 characters remaining
* The materials will be used only for nonprofit/educational purposes.
* The materials will not be used to manipulate or fallaciously market multi-center organizations. The materials will ONLY be used for those multi-center’s locations that are certified.
*The above-named certified center will not release the materials to any other nonprofit or commercial entity without seeking my permission.
This authorization is valid for 3 years from the date your Certified Urgent Care designation was placed and may only be withdrawn by UCAOA's specific rescission of this authorization. At that time your rights to use the logo will be pending your certification designation renewal status. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

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