Consent for Transfer of Medical Records Form

Consent for Transfer of Medical Records

    Pet Information

    I,

    (Owner Name)* the undersigned, do hereby authorize

    (Veterinary Hospital/Clinic)* to disclose and transfer my personal information and my pet(s) medical records to Sage Creek Animal Hospital.

    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: 204-255-1244