Medical Records Release
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Email *
Date *
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Pet's Name
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Owner's Name
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Facility for records to be released to:
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By typing my name below, I authorize Knoxville Animal Clinic, LLC to release my pet's medical records to be sent via email, fax, or mail to the facility listed above.
 *
Please provide the email address, fax number, or mailing address for the facility if known:
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