Medical Record Release Transfer

Medical Record Release Transfer

Medical Record Release Transfer

Medical Records Release

Pet's Name(s):

Please transfer records to:

Fax

Email

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

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.

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.

You may receive appointment reminders via text message. You can opt out of these reminders at any time.
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for your cats, dogs, and equine/horse chiropractic.
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NORTH LOGAN
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