Request for medical records

Request for medical records

Bytown Cat Hospital (422 McArthur Ave., Ottawa, ON K1K 1G6) Merivale Cat Hospital (1038 Merivale Rd., Ottawa, ON K1Z 6A7)
You may wish to have a copy of your cat's medical record for various reasons, such as for a pet insurance company, for another veterinary hospital (if you move), or for your own files. Please fill out this short form to initiate your request.

By using this form, you are helping us protect your privacy and streamline the process. It also allows us waive the charge for providing copies.

In most cases, we can provide a copy within three business days.
- Date
  
  MonthDayYear
  Date
- Which of our hospitals cares for your cat (s)?
- Your name
  
  First NameLast Name
- Your email address
  example@example.com
- Please let us know which cat(s) medical records to send
- Your cat's name
- Do you want the medical records for a second cat?
- Your second cat's name
- Do you want the medical records for a third cat?
- Your third cat's name
- Your fourth cat's name
- Please let us know why you are requesting the medical record(s).
  
  Other
- Where are the medical records being sent? Unless another email address is provided, we will send them to the email address you entered above.
  
  Other
- We can submit your claim directly to Trupanion. Would you like us to submit it for you?
- Please provide the email address the medical record should be sent to.
- We can send the medical record to the veterinary clinic for you if you enter the email address below.
  Email address
- Would you like to have a copy of the medical record for your own files? If so, we will send it to your email address.
- Are you changing permanently to another veterinary hospital?
- Under the Personal Information Protection and Electronic Documents Act and the Veterinarians Act only the legal owner or an authorized representative can consent to release of medical records.
- Under the Personal Information Protection and Electronic Documents Act and the Veterinarians Act only the legal owner or an authorized representative can consent to release of medical records. I confirm that I am the legal owner or an authorized representative of the cat(s) described above.
- Signature
- Should be Empty:

Request for medical records

Please let us know which cat(s) medical records to send