The information to be released includes:
**By signing this form, I am also authorizing Hebron Animal Hospital to obtain any records for the above mentioned animal/s from any previous Veterinarian, Shelter, Rescue or other facility.
I hereby certify that I am the owner or authorized agent of the owner of the above-described pet/s. Further, I hereby request and authorize Hebron Animal Hospital to release the requested medical information for my pet/s to the above-named facility(s). I release the Hebron Animal Hospital, their veterinarians and staff from any and all legal liability for the release of information to the extent indicated and authorized herein. I may revoke this authorization in writing at any time. The Hebron Animal Hospital policy is to provide the requested release within two (2) business days of the written request.
