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Medical Records Release Form
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Medical Records release form
I hereby authorize the Peace Arch Veterinary Hospital to release my pet’s medical records to
*
Email
E-mail where records need to be sent*
Name
*
First
Last
Pets Name/Speices
*
Name
Species
Phone number on file
*
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 pet(s). I release the veterinarian and staff from any legal responsibility or liability for the release of information to the extent indicated as authorized herein.
*
Δ
New Clients
New Client Registration Form
About Us
Our Team
Gallery
Insurance & Financing
Apply for Financing
Pet Insurance
Services
Wellness and Vaccination Programs
Geriatric Wellness Care
Medical Services
Dental Care
Surgical Services
Preventive Services
Pet Anesthesia
Health Screening Tests
Nutritional Counseling
Emergency Care
Urgent Vet Care
Vaccinations
At Home Euthanasia
Additional Services
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
Pet Food Recalls
Product Recalls
News
Contact Us
Schedule an Appointment
Medical Records Release Form
Online Store