Mandarin Animal Hospital | Jacksonville Veterinary Care | FL

Request for Records Form

To request copies of veterinary records from Mandarin Animal Hospital please complete this form. All fields are required. Please allow 1-2 business days for completion.

If you prefer you may also print this form and bring it with you on your visit. Click here for a Printable PDF

    Requesting Clinic Information

  1. Pet/Client Information

  2. I hereby certify that I am the owner (Pet Parent) or authorized agent of the Pet Parent of the above-described pet(s). Further, I hereby request and authorize this veterinarian to release the requested medical information for my pet(s). I release the veterinarian and staff from any legal responsibility or liability for the release of information to the extent indicated as authorized herein. This authorization expires 90 days from the date of signature. I understand I may revoke this authorization, but the revocation may not be applied retroactively once the information specified herein has been released.


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