Medical Records Release Form

To comply with the American Veterinary Medical Association's Principles of Veterinary Medical Ethics regarding medical records, Social Circle Veterinary Hospital requires written authorization from a pet owner before releasing medical records to another veterinary practice or authorized third party.

To request your pet's medical records, please complete and submit the Medical Records Release Form below. Once we receive your request, our team will prepare your pet's records and securely send them to you or the veterinary practice you designate.

Digital medical records are provided as electronic summaries of your pet's visits and will be emailed at no charge to the email address specified below for receiving the records.

First Name*:

Last Name*:

Address*:

Address, Line 2:

City*:

State*:

Zip/postal*:

Email*:

Phone*:

Pet Information

Pet Name 1:*

Pet Name 2:

Pet Name 3:

Request Type

What best describes your request?*

I am the pet owner requesting a copy of my pet's medical records.

I am the pet owner requesting that my pet's medical records be sent to another veterinary clinic or authorized third party.

Email to send records to:*

Receiving Party Name:

If sending to a clinic or third party, name must be entered for request to process.

Additional Notes:

Type Full Name:
By typing your full name below, you certify that you are the owner or authorized party for the pet(s) named above and you authorize the release of the requested medical records. Your typed name serves as your electronic signature.*

Medical Records Release Form

Pet Information

Request Type

Explore