Release of Vet Records to:
Creekside Veterinary Clinic 1529 State St, Black Earth, WI 53515
I request and give permission to have my complete records transferred to Creekside Veterinary Clinic and/or Creekside Pet Grooming. Please send records to vetcarecreekside@gmail.com or fax to 608-767-1403. Please inactive my account after sending records. Thank you for your cooperation. If you have any questions please call 608-767-1400.
Please list your pet(s) names (all pets can be included on one form) and the veterinary clinic name you would like your records transferred from:
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Your Name
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First Name
Last Name
Your Email
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example@example.com
Your Phone Number
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Please enter a valid phone number.
Signature
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Should be Empty: