New Client Consent to Release Information New Client Consent to Release Information Name * Name First Name First Name Last Name Last Name Email * Consent to Release Information Regarding your Pet The state of New Hampshire requires pet owners give consent to release medical information regarding their pet. Your privacy is of utmost importance. If any medical record information is to be shared with boarding/daycare/grooming/insurance companies/veterinary hospitals we need your consent to do so. We can call you every time this occurs OR signing below with a YES or a NO you can direct consent on your pet's medical record should any of these facilities call. If you do not give us consent to release the information below, we will not release the information but we would call you instead before any consent would be given. Please keep in mind if you decide not to give consent, it is possible your pet may be declined for boarding, daycare, grooming, insurance reimbursement, and/or treatment until they receive the information they need. BOARDING/DAYCARE/GROOMING FACILITIES Consent to release my pet's vaccine information to boarding/grooming/daycare facilities * Yes, I consent No, I do not consent Consent to release my pet's fecal Information, including results to boarding/grooming/daycare facilities * Yes, I consent No, I do not consent PET INSURANCE Consent to release your pet's records to pet insurance providers * Yes, I consent No, I do not consent VETERINARY HOSPITALS/EMERGENCY VETERINARY HOSPITALS Consent to release your pet's records to veterinary hospitals/emergency pet hospitals * Yes, I consent No, I do not consent If you are human, leave this field blank. Next
