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Authority for Release of Medical Information

Medical Authorization Form For Pets In Harris

Category:

Releases and Waivers - Medical

State:

Multi-State

County:

Harris

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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Please fill out our New Patient Form using one of the options below if your pet is a new patient at Harris Parkway Animal Hospital. This authorization expires 30 days from the date of signature.Arrive approximately 10 minutes early to fill out our New Patient Form. To save a bit of time, you can complete the New Patient Form online in advance. For your pet's health and others in our care, we require vaccines and deworming to be current. Please provide appropriate records if given elsewhere. All dogs and cats must be kept under restraint while in the unincorporated areas of Harris County, Texas. I confirm that my pet (referred to above) is current on the required vaccinations and has had a negative stool sample within the last year. How to fill out the Pet Care Emergency Authorization Form - Quick Guide?

Medical Authorization Form For Pets In Harris

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