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Authority for Release of Medical Information

Medical Authorization Form For Pets In Alameda

Category:

Releases and Waivers - Medical

State:

Multi-State

County:

Alameda

Control #:

US-00426

Format:

Instant download

Description

Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.

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These forms will come in handy if your pet ever needs care and you are not around to provide it. Simply click, print and fill out.AAH New Patient Information Request. Please complete this form so that we will be informed as to your pet's health condition and what you would. Alameda Animal Hospital. 925 S. Alameda St. Compton, Ca 90220. 310-638-4149. Standard Consent And Release Form. Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit. Please completely fill in ALL areas to include the following: • Patient Information: Patient Name, Patient Date of Birth and Phone. Number. I accept financial responsibility for the emergency care of the animal(s).

Medical Authorization Form For Pets In Alameda

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