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Records Release Form
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Thank you for choosing Aspen Animal Wellness!
Please complete this form to authorize the release of your pet’s medical records.
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Client Name
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First
Last
Phone
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Email
*
Patient's Name
*
Previous Veterinarian/Clinic
*
Previous Veterinarian/Clinic Phone
Previous Veterinarian/Clinic Email
I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal above and understand that by signing this agreement I authorize the veterinarians at Aspen Animal Wellness to receive the medical records for this pet.
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Date
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