Companion Record Release
Due to new laws and regulations passed by the State of Tennessee we are no longer allowed to provide groomers, boarding kennels, other veterinarians or non-family members with medical information about your pet including vaccination information without your written consent.
In order to avoid last minute emergency situations while you are trying to drop off your pet at the groomers, boarding kennel or other situations, PLEASE CHOOSE ONE ,THEN SIGN AND DATE AT THE BOTTOM OF THE PAGE.
RELEASE ALL medical records needed on any of my pets to anyone who requests them.
DO NOT release any medical records on any of my pets.
To anyone who request records
To our groomer
Name of Groomer
To our Boarding Kennel
Name of Kennel
To all Veterinarians including specialists
To only the following veterinarian(s)
Name of Veterinarian or Hospital
To only the following family of friends:
List names and phone numbers
Thank you, Dr. Ergen
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service