Medical Records Release Form
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Download Our App
(616) 241-6369
Services
All Services
Feline Care
Diagnostics
Dental Care
Surgical Procedures
Holistic & Alternative Care
Radioactive Iodine Treatment
Feline Behavior Counseling
Feline Grooming
Pharmacy & Pet Products
Emergency Pet Care
Close
Feline Boarding
Hours & Location
About Us
Our Practice
Meet the Team
News & Articles
Careers
Policies & Payments
Additional Locations
Resources & Links
Close
Contact
Contact
Book an Appointment
Client Forms
Refill Request
Medical Records Release Form
Close
Medical Records Release Form
I request that summaries or copies, as required by state law, of the medical records pertaining to my animal(s) named below be released upon request.
Pet Name:
*
I authorize Kentwood Cat Clinic to release my pet's records
*
yes
no
**This release will remain in effect until you notify us in WRITING of any desired changes****
Date:
Submit
