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Hours 2665 5 Mile Road NE
Grand Rapids, MI 49525

Medical Records Release Form

I request that summaries or copies, as required by state law, of the medical records pertaining to my animal(s) named below be released upon request.

Pet Name:*

I authorize Cat Clinic North to release my pet's records*

yes

no

This release will remain in effect until you notify us in WRITING of any desired changes**

Date:

Cat Clinic North