I hereby certify that I am the owner or authorized agent of the owner of the above described pet. Further, I hereby request and authorize Hilltop Animal Hospital, to release the requested medical information for my pet to the following Veterinary Clinic(s) and/or boarding/grooming facilities.
I release Hilltop Animal Hospital, their veterinarians and staff from any and all legal liability for the release of information to the extent indicated and authorized herein. I may revoke this authorization in writing at any time.