VETERINARY MEDICAL RECORDS RELEASE FORM Date: Client: Phone: Email: Address: City/State/Zip: I, the undersigned do hereby grant my permission for the release of any or all the information contained in the medical record of the pet listed to be given upon request to________________________________________________________________________ Pet Name(s) For Release of Medical Records 1): 2): 3): 4): 5): 6): 1 Client Signature:_______________________ ____________________ Date: 2Foxit Reader PDF Printer Version 9.7.1.2227