Skip to content
Our team is GROWING! Learn more about our openings by clicking
HERE
!
920-725-8307
Call
Make An Appointment
Home
Our Hospital
Our Doctors
Forms
AAHA Accredited
Hospital Tour
Careers
Services
Wellness Exams
Dental Care
Vaccinations
Microchipping
Spay & Neuter
Senior and Geriatric Wellness
Surgery
In-House Laboratory
End of Life Care
Happy Visit Mondays
View All Services
New Clients
Payment Options
News
Donate to Paisley Paws
Download Our App
COVID-19
Shop Online
Contact Us
Home
Our Hospital
Our Doctors
Forms
AAHA Accredited
Hospital Tour
Careers
Services
Wellness Exams
Dental Care
Vaccinations
Microchipping
Spay & Neuter
Senior and Geriatric Wellness
Surgery
In-House Laboratory
End of Life Care
Happy Visit Mondays
View All Services
New Clients
Payment Options
News
Donate to Paisley Paws
Download Our App
COVID-19
Shop Online
Contact Us
Make An Appointment
920-725-8307
Home
»
Record Release Authorization Form
Record Release Authorization Form
Owner Name
(Required)
Date
(Required)
Select an option
(Required)
All pets
Specific pet(s)
Client's Phone Number
(Required)
Which Specific Pets?
How would you like to release your pet records?
(Required)
I authorize Appanasha Pet clinic to release my pets records to any requesting clinic, emergency facility, boarding or grooming facility, rescue, or shelter.
I do NOT authorize release of my pet’s records.
I prefer a phone call or correspondence at the time of request to release records.
Signature
(Required)
Reset signature
Signature locked. Reset to sign again
This form is valid for one year from date of signature. If you choose all pets, the form will be linked to all active pets on your account. If you choose to mark a specific pet (s), the record release will only be linked specifically to that preferred pet (s). If you have any questions, please call Appanasha Pet Clinic at 920-725-8307.
Pharmacy
Find Us
Services
