New Client Registration Form

  • 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.