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Pet Insurance Records Request Form
Please allow 48 hours for a records request to be processed.
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Client Name
*
First
Last
Phone
*
Email
*
Patient Name(s)
*
Pet Insurance Name:
*
Pet Insurance email for records to be sent:
*
Date range of records requested
*
**Note:
Completion of this form is your authorization for Healthy Paws Animal Hospital to provide requested records to the specified pet insurance.
When your pet’s records are emailed to the specified pet insurance, your email address on file will be included, so that you have verification of records sent.
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