New Client Form

Authorization to Release Veterinary RecordsIn accordance with the Veterinary Practice Act regarding the confidentiality of patient medical records, a written authorization or other form of waiver executed by the client or an appropriate court order or subpoena is required in order for St. Matthews Animal Clinic to produce copies of your pet’s medical records. Medical records released shall not contain any financial information of the owner. Only medical treatment records shall be released.

I certify that I am the sole and rightful owner of the patient or that I am acting as a legal agent for the owner. I understand that full payment is due at the time service is rendered.