Medical Record Request Form

Please fill out the form below to request your pet’s medical records.

Name

First

Last

Phone

Pet's Name

Date of request

Reason for request

Personal Copy

Transferring Care

OtherOther

Email address or fax number where you would like the records sent

Hospital name

Hospital email address

Medical record requests are considered non-emergent.
Records will be processed and sent within 48–72 business hours from the time of request.
Once records are sent, your pet’s file will be marked as inactive, and you will no longer receive service reminders from our hospital.

I authorize the release of my pet’s medical records and acknowledge the terms listed above.

I authorize

Signature

Today's Date

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