Medical Release Consent

McGehee Clinic for Animals

712 Mt. Moriah

Memphis, TN 38117

901-682-5684

mcgeheeclinic@mcgeheeclinic.com
Consent form to Release Medical Records
Date

MonthDayYear
Please release my pet ________ vaccination records

YesNo
Pets Name:
Clear
Please release my medical records including: office notes, x-rays, operative reports, and any information regarding medical consultations and treatments my pet _____________ has received

YesNo
Pets Name:
Clear
Should be Empty: