Online Forms

Release of Information Form

Thank you for choosing Creekside Veterinary Hospital! Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

I herby authorize Creekside Veterinary Hospital to release information, medical records, or a summary of my animal’s medical records. I understand that this service is free of charge and routinely takes up to 48 business hours to complete. *

I have read and understand.

Please email to:

Name *

Myself *

(Email address)

Another Veterinary Hospital

(Email address)

In the case that we have 2 patients with the same name, and to help assure this form is not being fraudulently sent, please answer the following:

My pet’s species and/or breed: *

My pet’s estimated age or birthday: *

My pet’s estimated weight: *

My pet’s estimated last visit date: *

My pet’s color or breed description: *

Creekside Veterinary Hospital and all it’s employees including the attending clinician are released from legal responsibility or liability for the release of this information to the extent indicated and authorized herein.

Owner’s Signature *

Date *

And, if applicable

Co-owner’s Signature

Online Forms

Release of Information Form

Release of Information Form

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