Authorization to Release Medical Records

Fill out the form below.

Please Note: All fields marked with * are required. If you have any questions, please feel free to contact us.

Clear Signature
Privacy of personal information is an important principle to Central Veterinary Services. In compliance with the federal Personal Information Protection and Electronic Documents Act (PIPEDA), we are committed to collecting, using, and disclosing personal information responsibly and only to the extent necessary for the goods and services we provide. The primary purpose for collecting personal information is to provide veterinary services.