Medical Record Release Form (to Vet)

Date*

Name*

First:

Last:

I request that Animal Health Clinic of Funkstown release my pet's medical records for the following pet(s):*

Hospital or clinic name to release records to:

Name of Veterinarian:

Hospital or clinic address*

Street Address:

Address Line 2:

City:

State/Province/Region:

ZIP/Postal Code:


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Our Hours

Mon:
Tues:
Wed:
Thurs:
Fri:
8:00am - 7:00pm
8:00am - 6:00pm
8:00am - 6:00pm
8:00am - 7:00pm
8:00am - 6:00pm

Our Funkstown veterinarians offer a wide variety of pet care services including spay and neutering, general exams, vaccinations, and much more. Contact Animal Health Clinic of Funkstown today to schedule an appointment at our Funkstown, Maryland veterinary office.

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