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(631) 351-6116

800 W. Jericho Turnpike,
Huntington. NY 11743

24hr Emergency Veterinarian Long Island NY

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24hr Emergency & Critical Care

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Home » Client Center » Record Release Form

Record Release Form

Marked Fields Are Required [*]

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Pet Name*
Reason for request*
- Insurance Purposes
- Second Opinion
- Moving
- Appt. with Specialist
- Personal Files
- Closer to Home
- Unhappy with Care
- Other
Please specify reason*

Email address records to be sent to:*

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Add additional recipients in a separate line.

Specific date range needed (e.g. 1/1/2025 – 6/6/2025):*

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Date records are needed by:*
MM slash DD slash YYYY
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Online Pharmacy

Specialty Veterinary Hospital

Locust Valley
Location

Long Island City
Location

Oyster Bay
Location

Huntington Village
Location