Please transfer records to:
Fax
Email
This agreement will remain in full force until
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: *
Phone
