Medical Records Consent Download Form Owner Name(Required)Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Pet InformationPet Name(Required)Species(Required)Sex(Required)Breed(Required)Color(Required)Age(Required)Previous Veterinary Hospital/Clinic(Required)Consent(Required) I, the undersigned, do hereby authorize the above mentioned to disclose and transfer my personal information and my pet(s) medical records to Sage Creek Animal Hospital.Signature(Required)Date(Required) Note: Some Veterinary Hospital/Clinics charge a fee to transfer records, please follow up with the other Veterinary Hospital/Clinic to ensure your records are transferred quickly and efficiently Note to Veterinary Hospital/Clinic: Please send complete Medical History and a Vaccine Certificate by Email (preferred) or Fax. Email: info@sagecreekanimalhospital.ca Fax: 204-255-1244CAPTCHA Δ
