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. – 7 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

Have a question?

Get in touch! Complete the form below if you have any non-medical questions and our team will be in touch. If you’re in need of immediate assistance or would like to make an appointment, please contact us at 585-394-3340 or fill out an appointment request form.

Name *

First

Last

Email *

Phone

How can we help you? *

Email

Ready to begin earning rewards?

Click the buttons below to download our app from the App Store or Google Play.
Click the “Log in” button on the right-hand corner to create your account.
Use the email address on file with us and a password of your choice.
You will then receive a confirmation email to verify your account.
Open the email and click the “Verify your email address” button.
You will automatically receive your first loyalty stamp once your email has been verified.
Your pet information will sync with our system and show up in the app the next day.

Have questions about our app? Call us for more information!

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