New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a blue * asterisk.
  • Owner's Name

  • Co-owner's Name & Contact #

  • Pet Information

  • I hereby authorize the staff of Haiku Veterinary Clinic to render any treatment which is deemed necessary to my pet(s)health while in the custody of the hospital. I understand that in the event of unusual emergency circumstances, the staff will make every attempt to contact me or my designated representative before, if time permits, proceeding with treatment. I understand that I will be financially responsible for all emergency procedures including the Estimate of Charges provided to me in person or over the telephone. I understand that professional fees are to be paid at the time of service rendered and a deposit is required for all pets admitted to the hospital.