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) MM slash DD slash YYYY 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
