New Patient Information Form

Happy Pets (808)353-8565 info@happypetshealth.com

If you have multiple pets, please fill out one form per pet.
Name of First Caregiver*

First NameLast Name
Preferred Pronoun
Email*
example@example.com
Mobile Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Second Caregiver

First NameLast Name
Preferred Pronoun
Email
example@example.com
Mobile Phone Number

Area CodePhone Number
Pet's Name*
Species*
Breed*
Sex*
Is your pet spayed or neutered?*

YesNo
Date of Birth*

MonthDayYear
Date
Color/Markings
If you would like to share a photo of your pet, we will use it in their file.

Browse Files

Cancelof
Name of ALL Veterinarian(s) you pet has seen in the last 2 years.*
What type of appointment you are interested in?
How did you hear about us?*
Who were you referred by?
Please let us know who referred you so we can thank them.
Appointment Policy:

In order to provide the best care possible and avoid increasing our fees to compensate for missed appointments, we require 24 hours notice for all appointment cancellations.

Appointments cancelled in less than 24 hours will be charged the full appointment fee. In addition, we are unable to accomodate appointments that arrive or call more than 10 minutes late for their scheduled appointment time.

Payment Policy:

Payment is due at the time of service. We accept cash, check, and all major credit cards.

Statement of Responsibility and Consent:

I am the guardian and/or agent of the above pet/patient and have the authorization to consent to treatment. I hereby authroize the treatment of my animal. I understand that acupuncture, herbs, homeopathy and/or manual therapy may be used in the treatment of my animal. I understand that if I desire a more conventional approach to the treatment of my animal, I may recieve a referral for such treatment.
Monthly Newsletter

I would like to subscribe to the Happy Pets newsletter for holistic information, special offers, and more.
I give consent to receive SMS messages from Happy Pets

YesNo
I give consent for my or my pet's photo to be on social media.

YesNo
Signature and Date: I have read and agree to the above policies. To sign, use mouse and draw signature.*

Clear
Should be Empty:

Happy Pets (808)353-8565 info@happypetshealth.com