MEDICAL RECORDS RELEASE
In accordance with the Kentucky Veterinary Practice Act regarding the confidentiality of patient
medical records, “a written authorization or other form of waiver executed by the client or an
appropriate court order or subpoena” is required in order for Bell County Animal Clinic to produce
copies of your pet’s medical records. Medical records released shall not contain any personal or
financial information of the owner. Only medical treatment records shall be released.
I certify that I am the sole and rightful owner of the patient or that I am acting as a legal agent for
the owner.
I hereby authorize the release of my pet’s medical records to:
