Medical Records Release Form

Name: Canandaigua Veterinary Hospital
Address: 4410 County Road 50, Canandaigua, NY, 14424, United States
Telephone: 585-394-3340
Price range: $

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Medical Records Release Form

I, the undersigned, do hereby grant my permission for the release of any or all of the information contained in the medical records of those pets listed below to the following person or veterinary practice:

Name *

First

Last

Email *

PET NAME(S) FOR RELEASE OF MEDICAL RECORDS

Pet's Name *

Pet's Name

Release RECORDS TO:

Today's Date *

Fax Number

Email

Reason for Request of Records:

Signature *

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Your preferred Canandaigua veterinary hospital.

Our veterinarians and staff have a long tradition of community service. Animals, medicine, and science are our passions, and we are devoted to treating every animal and owner as a trusted friend. We serve the communities of Canandaigua, Bloomfield, Shortsville, Farmington, Phelps, and Clifton Springs.

Contact

P: 585-394-3340

F: 585-394-5424

E: info@canandaiguavet.com

Hours

Mon – Thu: 8 a.m. – 6 p.m.
Fri: 8 a.m. – 5 p.m.
Sat: 8 a.m. – 2 p.m.
Sun: Closed

Location

4410 County Road 50,
Canandaigua, NY 14424

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