Click Here to download Vet Records Release Form to sign and fax or email.

Complete Form Electronically:

    Your Name (required)

    Street Address (required)

    City, State, Zip Code (required)

    Telephone (required)

    Your Email (required)


    Information Authorized for Release:

    Do Not Release Any InformationShare Any InformationShare Only Vaccine Due Dates

    I, the undersigned do hereby authorize The Animal Medical Clinic to release the above information contained in the medical record of the pet(s) listed to be given upon request. This release will remain in effect until I notify The Animal Medical Clinic in writing of any desired changes.

    Electronic Signature (type name)(required)