Medical Records Release Form at Animal Health Care Center of Renton

Need to transfer your pet’s medical records? Complete the form below to authorize the release of records from your previous veterinary provider. We’ll take care of the rest.

Get Started

Complete the Form

Your Name *

First

Last

Email *

Your transfer this

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Pet’s Names

Enter pet's name *

Veterinary Details

Name of Veterinary Practice Where My Pet’s Records Are Currently Held *

Veterinary Practice Address

Address Line 1

Address Line 2

City

State

Zip Code

Veterinary Practice Phone *

Veterinary Practice Fax & Email (if known)

I request that copies or summaries, as required by state law, of the medical records pertaining to my animals to be released to:

Animal Health Care Center
504 Renton Center Way SW #3
Renton WA 98057
425-203-9000 office
425-277-0956 fax
www.ahrenton.com

I hereby authorize and provide my written consent to this transfer of medical information. *

I hereby authorize and provide my written consent to this transfer of medical information.

Signature *

Clear Signature

Today's Date *

Medical Records Release Form at Animal Health Care Center of Renton

Complete the Form

Pet’s Names

Veterinary Details

Make an Appointment with Us Today!

Come visit us today