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.
To anyone who request records
Digital Signature
Your answer
To our groomer
Name of Groomer
Your answer
To our Boarding Kennel
Name of Kennel
Your answer
To all Veterinarians including specialists
Digital Signature
Your answer
To only the following veterinarian(s)
Name of Veterinarian or Hospital
Your answer
To only the following family of friends:
List names and phone numbers
Your answer
Today's Date
MM
/
DD
/
YYYY
Your Name
Your answer
Thank you, Dr. Ergen
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