Medical Records Release

Pet's Name(s):

Please transfer records to:

Fax

Email

This agreement will remain in full force until

If no end date is selected then authorization is in effect until we receive written notification from you to end the authorization

Additional Instructions

By submitting below, I authorize Mountain View Veterinary Health Center and give written consent to release vaccine records and other pertinent medical information on my pet(s) to the above listed person or facility. I certify I am the owner or authorized agent of the owner of the pet(s) identified above and that I am eighteen years of age or over.

Please Type your name: *

Date: *

Email: *

You will receive pet health reminders, appointment reminders and other information from us through email. You can opt out of any type of email communication through our online portal or the email itself.

Phone

You may receive appointment reminders via text message. You can opt out of these reminders at any time.

REQUEST APPOINTMENT
for your cats, dogs, and equine/horse chiropractic.

NORTH LOGAN
PROVIDENCE
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ONLINE STORE

Both practices will be closed on the first Tuesday of every month until 9:30 AM.
For information regarding clinic closures, please visit our social media pages.

Mountain View Veterinary Health Center is an accredited member of the American Animal Hospital Association (AAHA). Mountain View Veterinary Health Center first received this accreditation in 1977 and is proud to have been the first hospital, and one of only two in Cache Valley, to have this accreditation.

Since 1977 Mountain View Veterinary Health Center has undergone regular inspections by AAHA to ensure compliance with the association’s high quality standards of care. These standards cover nearly every aspect of the Mountain View Veterinary Health Center hospital, including: surgery, pharmacy, laboratory, exam facilities, pet health records, cleanliness, emergency services, dental and nursing care, diagnostic imaging, anesthesiology, and employee training and education.

Medical Record Release Transfer

Medical Record Release Transfer

Medical Record Release Transfer

Medical Records Release

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North Logan

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Medical Record Release Transfer

Medical Record Release Transfer

Medical Record Release Transfer

Medical Records Release

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