Medical Records and Information Release
In accordance with Tennessee's veterinary rules and regulations, written consent is required for Animalia to share any of your pet's medical information with non-clients, including vaccine information. Please provide authorization below to Animalia in order to release medical records and information. This would pertain to any current or future pets on your account.
Email *
Date *
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Client Name (First & Last) *
All Veterinary Clinics & Hospitals *
All Pet Boarding, Grooming, Daycare Facilities, and Rescue Organizations *
Pet Insurance Companies *
May we have permission to use photographs and/or video of you or your pet(s) in clinic displays such as brochures, online platforms, or educational presentations? *
Do you have a social media handle you would like us to tag? *
Authorized Party Names & Phone Numbers (please indicate spouse, partner, pet sitter, etc.) *
I certify that I am the client listed above, I am at least eighteen (18) years of age, and the above information is correct. *
Required
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