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Records Release Consent
Please complete these questions to authorize us to transfer your records.
Name
*
First
Last
Email
*
Phone number you can be reached at
*
Pet Name
*
What is the clinic name for the records to be transferred to?
*
What is the clinic phone number for the records to be transferred to?
*
What is the clinic email for the records to be transferred to?
*
What is the reason you are leaving our clinic?
*
We understand understand we are not the right clinic for you and we are saddened by your departure, please us know here if we could have done anything different, we only wish to improve our services and and client care.
I authorize the transfer of my pets records to the clinic listed above.
*
I understand that if I have an outstanding balance on my account, this will have to be paid prior to any transfer of records. (*)
Any other information we should know?
Thank you for your trust over the years and we wish you all the best.
-The doctors and staff of Roncesvalles Animal Hospital
Δ
Home
Services
Pet Medical Services
Surgical Services
Preventive Services
Nutritional Counseling
Wellness & Vaccination
Anesthesia & Monitoring
Health Screening
Additional Pet Services
About Us
Meet Our Team
Cancellation Policy
Our PetPage App
Our Blog
Pet Health
Pet Health Library
How-To Videos
Pet Health Checker
Pet Food Recalls
News
Blood Donor
Helpful Links
Forms
NEW Client Registration
Make an appointment
Rx Refill & Food Request
Compassionate Care Consent
International Travel
Records Release Consent
Contact Us
Make an Appointment
Emergency
Online Store
facebook
instagram