SHERIDAN ANIMAL HOSPITAL 2288 Sheridan Drive • Buffalo, New York 14223 Telephone (716) 833-5345 • Fax (716) 833-8525
Request for Transfer of Medical Records
By law, Original medical records must be retained for five years after the last entry. However, a copy or summary of the information contained in these records can be forwarded. The confidentiality of your pet’s health information is very important. Accordingly, we ask you sign where indicated to authorize the release of your pet’s medical information. A separate form must be completed for each pet.
Birthdate or Age:*
I authorize the release of a copy of the medical records for the above animal.
From: Sheridan Animal Hospital Address: 2288 Sheridan Drive Phone: (716) 833-2255 Fax: (716) 833-8525 Email: Email Us Online Website: www.sheridananimalhospital.com
Hospital Fax Number:*
Note: Sheridan Animal Hospital will email records to hospital within two business days of receipt of this request.
Is this a permanent transfer? YesNo
If "yes" - owner acknowledges that we will no longer have a Veterinarian client/patient/doctor relationship at our hospital. This means you will no longer receive any future reminders and will be unable to receive any services, medications or prescription food from Sheridan Animal Hospital from this date forward.
Client's Electronic Signature:
Reason for transfer:
Send Us A Line! Phone: (716) 833-2255 Fax: (716) 833-8525
Veterinary Specialists of WNY: (716) 833-5345
Get Directions 2288 Sheridan Drive Buffalo, NY 14223
M, W, F 7am – 6pm T, TH 7am – 8pm Saturday 8am – 12pm Sunday Closed