I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pets. I assume responsibility for all charges incurred in the care of these animals. I also understand these charges will be paid at the time of patient release and that a deposit may be required for surgical treatment.

I give Tazewell Pike Animal Clinic permission to release my pet(s) medical/vaccine records at any time a request is made. Furthermore, I realize I must request in writing when I no longer wish this to be in effect.

From the Licensing Board Just a reminder that Rule 1730-01-13 (6) specifically states that client records can only be released with the written permission of the client. The Board has stated that this includes requests of vaccination records from other veterinarians, groomers, and boarding facilities. For more information about this Rule, please see the Board's Policy Statement regarding Release of Patient Records at Board of Veterianry Medical Examiners-TN.gov