• In accordance with the Veterinary Practice Act regarding the confidentiality of patient medical records, “a written authorization or other form of waiver executed by the client or an appropriate court order of subpoena” is required in order for Animal Hospital of Nicholasville to produce copies of your pet’s medical records.Medical records released shall not contain any personal or financial information of the owner. Only medical treatment records shall be released.
  • Date Format: MM slash DD slash YYYY
  • I hereby authorize the release of my pet’s medical records to:

  • Please check below where we have your permission to leave a confidential message (e.g. lab or test results, prescription information, etc). Leave the space(s) blank if you do not wish to receive messages.
  • I certify that I am the sole and rightful owner of the patient or that I am acting as a legal agent for the owner.