Veterinary Records Release Request

Save time during your next appointment! Complete your required new client form online from any device at any time before your visit.

Veterinary Records Release Request Form

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.

Your Full Name *

Cell Phone Number *

Email Address *

Pet Name(s) *

Previous Veterinary Clinic's Name *

Clinic's Authorization Your

Clinic's Email *

Clinic's Phone *

Authorization *

By clicking “Submit,” I authorize my pet’s previous veterinarian to release medical records for the pet(s) listed above to Ridgefield Veterinary Center. I understand this request will be sent by email to the veterinarian’s office using the contact information I have provided, and I am responsible for ensuring the accuracy of that information. I acknowledge that this form serves as my digital authorization and carries the same validity as a signed paper release.
I authorize my previous veterinary clinic listed above to release my pet’s medical records to this hospital. I confirm that the information provided regarding my previous veterinarian is accurate and complete.

Your Signature

Clear Signature