• Medical Records Release Authorization

  • I,         , authorize the release and transfer of medical records for my pet(s) indicated below. Unless otherwise stated release will include exam, summaries, vaccination history, lab, imaging reports, and radiographs.
    Pet Information:
        

    Please and send to:
    Indicate how you would like to have your records sent:
       


    If requesting records be emailed, please provide email address: 
          

       
       


          

  • I certify that I am the legal owner, or authorized agent for the legal owner. I release the South Bay Veterinary Hospital form any legal responsibility or liability for the release of information authorized above.

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