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Brandon Lakes Animal Hospital
Records Release
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Name
*
First
Last
Email
*
Pet's name
New Animal Hospital Name:
*
Signature
*
Clear Signature
I, the undersigned, authorize Brandon Lakes Animal Hospital, and Mark R. Woodside, DVM, to release the full medical records of the above named pet(s) to the animal hosptial above. By signing this document, I hereby release Brandon Lakes Animal Hospital and Dr. Woodside from any liabilities regarding release of the records.
Date / Time
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