Request Records Form

Thank you for choosing Northwest Animal Hospital! Please fill out the form as completely and accurately as possible.

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Request Records Form

Request Records Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 847-296-3112 for a faster response.

In accordance with the Veterinary Practice Act regarding the confidentiality of patient medical records, a written authorization is required in order for Northwest Animal Hospital to produce copies of your pet’s medical records. Medical records released shall not contain any sensitive personal or financial information of the owner. Only medical treatment records shall be released.

To request copies of veterinary records from the Northwest Animal Hospital, please complete this form. All fields are required. Please allow 2- 4 business days for completion. We may contact you via email or phone to verify your request. Thank you.

Pet Information

Release Pet's Medical Records To An Animal Hospital: