Record Release Form

Marked Fields Are Required [*]

"*" indicates required fields

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:*

Add additional recipients in a separate line.

Signature*

This field is for validation purposes and should be left unchanged.

24hr Emergency & Critical Care Center

Clients of Locust Valley Veterinary Clinic never pay any additional emergency fee when being seen at West Hills Animal Emergency & Critical Care Center for after hour emergencies.

Hospital Forms

Online Pharmacy

Specialty Veterinary Hospital

Huntington Village
Location

Long Island City
Location

24hr Huntington
Location

Oyster Bay
Location

Record Release Form

Hospital Forms

Links

Hospital Affiliations

Appointment Hours