Authorization For The Release Of Medical Records

Authorization For The Release Of Medical Records
By click on below checkbox I, authorize the release of all medical and surgical records for my pet including but not limited to written medical records, radiographs, lab test and any other information pertinent to my pet. By doing so, I release The Pet Doctor and any of its agents and employees from any responsibility with regards to the HIPA laws regarding confidentiality.

Date: 09/28/2021

Accept Terms *

2562 Francis Lewis Boulevard
Flushing, New York 11358
Directions
(718) 886-6661
petdoctor01@gmail.com