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New Client

New client form
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New Client Form

Authorization to Release Veterinary Records

In 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.
Click or drag a file to this area to upload.
If you have a digital copy of your pet's records, please upload here.

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.

By typing your name, you are agree to all terms & condition listed out on this form.