Bright Futures Farm

44793 Harrison Road

Spartansburg, PA  16434

Phone: 814.827.8270

 email:info@brightfuturesfarm.org

RECORD RELEASE

DATE: __________

HORSE: _______________

NAME & ADDRESS OF VETERINARY PRACTICE USED: _________________________________________________

                                                              _________________________________________________

                        PHONE OF VETERINARY PRACTICE:__________________OFFICE MANAGER:_____________________

                                                NAME OF YOUR PRIMARY VETERINARIAN  ___________________________

I have adopted the above named horse from Bright Futures Farm.  I hereby give permission to Beverlee Dee and/or a representative of Bright Futures Farm to access full medical history on the horse listed above at any time from my Veterinarian. 

I also give permission for Beverlee Dee and/or a representative of Bright Futures Farm to discuss a diagnosis, prognosis, and/or treatment with any or all of the Veterinarians on staff at your practice.

Finally, if I should return said horse to Bright Futures Farm for any reason, I give permission for all accumulated veterinary records for said horse to be released to Bright Futures Farm, attn:  Beverlee Dee, 44793 Harrison Road, Spartansburg, PA  16434.  If there is a cost to provide these records to Bright Futures Farm, I __________________________________, will incur that cost.

_________________________________ DATE: __________________

Adopter

Once signed, please make a copy for your veterinarian’s files, and one for yourself.

Return original, signed copy to Bright Futures Farm, Inc.