Medical Information ReleaseForm

At Vestal Veterinary Hospital, we take your pet’s health information seriously and ensure it’s shared only with your consent. Please complete the form below to authorize the release of your pet’s medical records to another veterinary clinic or authorized party.

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Secure and Confidential Record Transfers

This Medical Information Release Form allows us to safely share your pet’s medical history when needed—such as transferring care, seeking a specialist’s opinion, or updating records at another facility. Your privacy and your pet’s well-being remain our top priorities.

Complete the Form Below

Name *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

I hereby authorize the party listed below to release my pet’s medical records to Vestal Veterinary Hospital for the current and/or ongoing care of my pet.

Hospital/Clinic

Patient Name

Species

Breed *

Age or Date of Birth *

Sex *

Medical records authorized:

Preventative health care received
All medical records
Specific information

Specific information regarding:

Signature *

Clear Signature

Hospital Name *

Hospital Phone

Hospital Fax

Phone

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Medical Information ReleaseForm

Secure and Confidential Record Transfers

Complete the Form Below

We Proudly Serve the Pets of Vestal, NY and Surrounding Communities

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