Briarwood Animal Clinic

1621 W 86th St
Indianapolis, IN 46260

(317)872-4326

www.briarwoodanimalclinic.com

Use this form when you are preparing to make the switch to join the Briarwood family! Some clinics/hospitals required permission from the client. Filling this form out will allow us to retrieve your furry friend's records from the previous veterinarian on your behalf.

Record Transfer Permission

Client Name
First Name
Last Name
Patient Name

Client Phone Number
Phone TypePhone Number
Client E-Mail Address :
By checking this box, you are agreeing to allow us to receive medical records from another hospital.
I agree

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