Medical Records Request

If you are a client of an AmeriVet practice that has closed, please use this form to request records for your pet(s). Please allow up to 5 business days for your request to be processed.

Your name *

First

Last

Practice name *

Pet's name *

Do you have another pet to add?

2nd pet?

Yes

Address on file *

Address Line 1

Address Line 2

City

State

Zip Code

Phone number on file *

Email (to send records) *

Additional comments/information

Custom captcha *

=

Name