Request Copy of Medical Records FROM BROOKFIELD

Please Complete the Following Fields To Have Your Pet's Medical Records Released

  • This email will only be used for the purposes of this records transfer
  • Please list the name(s) of the pet(s) whose medical records you would like transferred.
  • Tell us why we are sending a copy of your pet's medical records from our office.
  • Only use this field if you are certain that this is the email address to where we can send a copy of the records.
  • By signing (or typing your name) below, you agree that you are at least 18 years of age, that you are the owner of the above mentioned pets, and that you would like a copy of your pet(s) medical records sent to the veterinarian/veterinary office listed above.