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Record Release Form at Healing Arts Veterinary Center

Need to transfer your pet’s records? Use our secure record release form to send or receive veterinary information with ease.

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Request or Transfer Your Pet’s Veterinary Records

Complete The Form

Medical records will be released upon the written authorization of the client or the client’s legal representative (Florida Statute 474.2165). All original documents and images are the property of Healing Arts Veterinary Center. Please allow 24 business hours (48 hours on weekends) for your request to be processed. Incomplete forms will be returned. Our office will not look up email addresses or other information, so please verify all destination details before submitting.

Owner's Name(Required)

Address(Required)

Address Line 1 Address Line 2 City State ZIP Code

Owner's Phone Number(Required)

Owner's Email(Required)

Pet(s) Name(s)(Required)

Release records to the following:

Name(Required)

Address

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Fax

Email(Required)

Please select:(Required)

Release my pet(s) vaccination history for daycare, boarding or grooming.

Release my pet(s) vaccination history, breed and size information for an HOA or travel.

Release my pet(s) Xrays. (A link will be emailed with instructions on how to download the images)

Release my pet(s) entire medical history

Release only the following information

Enter Information(Required)

Reason for Request(Required)

Would you like to keep your account with our office open?(Required)

Yes

Signature(Required)

Today's Date(Required)

Record Release Form at Healing Arts Veterinary Center

Request or Transfer Your Pet’s Veterinary Records

Complete The Form

Release records to the following:

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