Medical Record Release Form

Name*
First Last
I certify that I am the owner or authorized agent of the pet(s) stated below. Further, I hereby request and authorize the release of medical records (including: laboratory results, vaccination records, exam reports, surgical and anesthesia records, pathology reports and radiographs) of my pet(s). Please forward my records to the Waverley Animal Hospital.*
- First Choice
Pet Names
Pet
Pet
Pet
Pet
Pet
Pet
Pet
Pet
Pet
Pet
Pet
Pet
Signature*
Date*
MM
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YYYY

Exceptional Pet Care in Waverley, NS!

Below you will find our contact information, we welcome your feedback

2400 Waverley Road
Waverley NS B2R 1Z1

Phone: 1 902 576 2068
Fax: 1 902 576 2103

Monday : 8 AM to 8 PM
Tuesday : 8 AM to 8 PM
Wednesday: 8 AM to 6 PM
Thursday: 8 AM to 8 PM
Friday: 8 AM to 6 PM
Saturday: Closed
Sunday: Closed