PET HEALTH

I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal (s) described below. I hereby give to the doctors of the Belleville Animal Clinic and their staff permission to release any and all medical  information pertaining to the animal (s) described below. For boarding, grooming, training purposes or other. 

I understand it may take up to 2 weeks to receive Belleville Animal Clinic requested pet medical records.