Information Request Form

Records Request

This form is for use by Veterinary Hospitals, Clinics, & Pet Insurance Companies only. If ONLY verbal vaccine verification is needed please call us at 561-625-6970.
When was the last time the patient was seen by Ibis Animal Hospital?

More recent than today’s date in 2020.Before today’s date in 2020.Unknown.

We no longer have records for this patient.

Ibis Animal Hospital maintains medical records for 3 years as required by law.
Record Request

This form is strictly for use by Veterinary Hospitals & Insurers only.

If you are a medical facility, groomer, or boarding facility & only need a verbal vaccine history/verification, please call our office at 561-625-6970.

While we do our best to complete all requests as soon as possible, non-emergency record requests for medical providers can take up to 14 business days to process. Requests for insurers can take up to 30 days to process.

Thank you for your patience & understanding as we prioritize patient care during these challenging times. If you have any questions, please contact Management@IbisAnimalHospital.com
Client & Patient Info
Client Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Purpose of the visit:*

Insurance Request; not a visit.Grooming/Boarding.Specialist/ERWe’re the Pet’s Other Seasonal VeterinarianSecond OpinionSwitching Vets CompletelyOther
Pet's Name(s):*
Requesting Practice or Insurer Info
Hospital or Insurer Name:*
E-mail:*
Fax Number:

Area CodePhone Number
Phone Number:

Area CodePhone Number
Staff Member Requesting:*
Continued
Please select the appropriate option.*

Patient is currently hospitalized with us for *emergency care*. If this is during our business hours, please call us at 561-625-6970).Patient has an appointment today for a non-emergency.Patient has an appointment within the next 72 hours.Patient has an appointment in more than 72 hours.This is for an Insurance Claim
Records Being Requested:
Please select all that apply.*

Vaccine HistoryRecent Lab Work (last 90 days)Medical Records from the last 12 MonthsMedical Records from the Last VisitOther
Is there anything else we should know?
If the patient is currently scheduled for an appointment at your practice, please note the date.

MonthDayYear
Date
Should be Empty:

Records Request

We no longer have records for this patient.