Medical Records Release Form

I hereby authorize the Peace Arch Veterinary Hospital to release my pet’s medical records to

First Name

Last Name

Pet 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.*

+1 (604) 536-3131

+1 (604) 536-3131

Medical Records Release Form