Records Request Form Submit this form to request medical records for patients previously treated at our facility. Records Request Form Client Name * Client Name First First Last Last Other Client Name(s) (Plese list all names on the account) Client Phone * Pet Name * Canine or Feline? * Canine Feline Name of Requesting Veterinarian * Veterinarian's Office * Veterinarian's Email * Veterinarian's Fax Number * Do you prefer the records be emailed or faxed to you? * Email Fax Comments Submit If you are human, leave this field blank.