• Medical Record Request

    Medical Record Request

  • I authorize Cornell University Hospital for Animals to release the above named patient medical records to:

  • I understand that by authorizing Cornell University Hospital for Animals, to use/disclose the information, that they may receive compensation for reasonable expenses incurred for making photo copies of medical records. I understand that I may revoke this authorization in writing at any time by contacting the medical record department, except to the extent that action has been taken in reliance on this authorization. This authorization expires(insert applicable date or event), on or within (6) months or the date of the authorization, whichever is greater.

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  • Your request is important to us.  Please allow 3-5 business days to complete your request. Please contact us at 607-253-3044 if you have any questions.

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  • Internal Use only:

  • Created 2/24

  • Should be Empty: