Please fill out the following questions prior to your up and coming clinic appointment:

Name*
First Last
Your Pet's Name*
Contact Phone Number*
Email*
Enter Email Confirm Email
Have you recently moved or has any of your information changed?*
- Yes
- No
Please add your new information below:
Street Address Address Line 2 City State ZIP Code
Any other changes to your contact information?
Has your pet experienced any vomiting, diarrhea or change in appetite? If so, when did it start? How frequently? What is the consistency?
Has your pet experienced coughing or sneezing? When did it start and how frequently? Is there any nasal discharge?
Please list what your pet eats in a day (include brands) with how often:
How often do you bathe your pet? What shampoo do you use?
How often do you clean their ears? What ear cleaner do you use?
How often do you brush their teeth?
Do you have any behavioral concerns?
What medications including preventatives and supplements does your pet take? What dose is given and how often?
Does your pet have any allergies, itching or skin lesions? Please send a picture or video if applicable of any physical changes to the skin, ears or eyes.
Upload a photo if applicable
How is your pet’s mobility? Any problems jumping, running or going up and down stairs?
Does your pet drink water more or less frequently?
- More frequently
- Less frequently
- The same
Any change in urination?
- Yes
- No
Please list any concerns you have that have not been addressed.

Haiku Veterinary Clinic

Welcome to Haiku Veterinary Clinic, your local veterinarian in Kaneohe. We’re pleased to provide a wide variety of veterinary services for animals in Kaneohe and surrounding areas.

About Us

Contact Us

Text or Call: 808-235-6405
info@haikuvet.com

Visit Us

45-773 Kamehameha Hwy.
Kaneohe, HI 96744

Our Hours

Monday-Saturday: 8:00am-5:00pm
Sunday: CLOSED
Temporary Hours, until further notice

Appointment Questionnaire

Haiku Veterinary Clinic

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