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1-805-904-6772 (Fax)
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MEDICAL RECORDS REQUEST FORM
If you are a veterinarian or a pet owner who used our services, please fill out this form to request a duplicate copy of the imaging results. If you are requesting a duplicate copy of an ultrasound CD or DVD, an additional fee may be required.
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Indicates required field
YOUR FULL NAME:
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First
Last
YOUR PET'S NAME:
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YOUR PHONE NUMBER:
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YOUR EMAIL:
*
HOSPITAL AFFILITATION (If Applicable):
*
Comment
*
Submit
