Medical Records Release Form

TO*

Name of Vet/Facility

Address*

Street Address:

Address Line 2:

City:

State/Province/Region:

ZIP/Postal Code:

Email Address*

Phone*

 I hereby request that a copy of the medical records of my animal(s) be released to Animal Health Clinic of Funkston*

Pet Name*

Name*

Frist:

Last:

Address*

Street Address:

Address Line 2:

City:

State/Province/Region:

ZIP/Postal Code:

Email*

Phone*


Contact Us

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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