ONLINE FORM

Medical Release Form

Save time during your appointment! Complete your required medical release form online before your visit.

Online Forms

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Download Form

Medical Release Form

Pet Parent Information

Client Name *

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Pet Information

Name *

Breed *

Do you have a second pet to add? *

Yes
No

***Attention Please***

Please keep in mind, we will only provide records for up to 3 years. If additional information is requested by the new hospital, there will be a record preparation fee. Please be advised it may take up to 3-5 business days to e-mail your medical records once our hospital receives your request.

Radiographs/imaging requests will be e-mailed directly to your new doctor and at the doctor’s discretion. This process could take up to 7-10 days.

Previous Hospital Name *

Previous Hospital Phone *

Previous Hospital E-mail Address *

I hereby certify that I am the owner (Pet Parent) or authorized agent of the Pet Parent of the above-described pet(s). Further, I hereby request and authorize this veterinarian to release the requested medical information for my (pets) to the above-listed contact. I release the veterinarian and staff from any legal responsibility or liability for the release of information to the extent indicated as authorized herein. *