Medical file copy request

I hereby authorise the Centre Hospitalier Universitaire Vétérinaire to copy the following file:
File number

Name of the animal (obligatory)

Owner name (obligatory)

Email adress (obligatory)

Phone number (obligatory)

Reason for obtaining copy: (obligatory)

Please note that you will be charged for the copy of your pet's medical file. We will contact you to inform you of these upon receipt of this form in order to obtain your authorization before proceeding.

The price is subject to change if the file is very large. In this case, you will be contacted directly to be notified.

Sending the copy by
MailFax

Address or fax number:

We will contact you soon for the payment and confirm your request.