MEDICAL RECORDS RELEASE
According to the Veterinary Privacy Act regarding the confidentiality of patient medical records, "a written authorization or other form of waiver executed by the client or an appropriate court ordered subpoena" is required in order for Buffalo Ridge Animal Hospital to produce and send copies of your pet's medical records. Medical records released shall not contain any personal or financial information of the owner. Only medical treatment records shall be released.
I certify that I am the sole and righful owner of the patient or that I am acting as a legal agent for the owner.
By completing this form, I hereby authorize the release of my pet's medical records to the mentioned hospital above.