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New Client Registration Form

YOU MUST BE AT LEAST 18 YEARS OLD TO MAKE MEDICAL DECISIONS FOR YOUR PET. ANYONE UNDER THE AGE OF 18 BRINGING IN A PET FOR AN APPOINTMENT WILL NEED TO HAVE SOMEONE OVER THE AGE OF 18 WITH THEM THROUGHOUT THE APPOINTMENT.

ALL DOGS MUST BE ON A LEASH AND ALL CATS MUST BE INSIDE A CARRIER BEFORE ENTERING OUR FACILITY. THEY ARE TO REMAIN ON THEIR LEASH OR IN THEIR CARRIER THROUGHOUT THEIR TIME IN OUR FACILITY UNLESS INSTRUCTED OTHERWISE.

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.

We require your previous pet records to be emailed or faxed to our clinic prior to scheduling an appointment. We process our new client forms in the order in which we receive them. Please allow 24 to 48 hours for processing this form. We will call you for an appointment once we have completed processing and have received your previous records.

Records can be sent via email to: reception@havelockanimalhospital.com Or Faxed to: 252-447-7444

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 red * asterisk.

  • Owner's Info

  • mm/dd/yyyy
    Date Format: MM slash DD slash YYYY
  • mm/dd/yyyy
    Date Format: MM slash DD slash YYYY

  • Your Pet's Health History (Pet Number 1)

  • Your Pet's Health History (Pet Number 2)

  • Cancellation Policy

  • Our goal is to provide quality individualized veterinary care in a timely manner. We would like to notify you of our office policy regarding missed appointments. This policy enables us to better utilize available appointments for our patients in need of medical care.

    Cancellation of an Appointment:
    We understand that occasional missed appointments can occur for a variety of reasons. Please call Havelock Animal Hospital promptly if you are unable to keep your scheduled appointment. This time will be reallocated to someone who needs treatment. If it is necessary to cancel your scheduled appointment, we require that you call at least 24 hours in advance.

    How to Cancel Your Appointment:
    To cancel appointments, please call 252-447-7119. You may leave a message on voicemail if applicable. We will not accept text or e-mail cancellations.

    Late Cancellations/Missed Appointment Policy:
    If you miss an appointment or fail to cancel with 24 hours advance notice of your appointment time, a $25.00 fee will be applied to your account. Surgery appointments will be charged a $100.00 fee. This fee will go towards the rescheduled surgery appointment. In the event the same surgery appointment is missed for a second time, the $100.00 fee is non-refundable. Clients who are ten ( l 0) or more minutes late to their scheduled appointment, and still want to be seen, will be assessed an urgent care fee in addition to the doctor's exam fee.

  • ALL CLIENTS WILL BE ASKED TO SIGN THE FOLLOWING:

  • Cancellations, Late Arrivals and Missed Appointments:
    Appointments cancelled with less than 24 hours' notice, as well as no-show appointments, are subject to a cancellation fee of $25 .00. Cancellation fees must be paid prior to scheduling your next appointment. Repeated cancellations will require full payment of expected fees when the appointment is scheduled.
  • Financial:
    Payment is due the date of service in the form of cash, Visa, Mastercard, AMEX, Discover or CareCredit. Checks are only accepted when the client's social security number is on file.
  • Refill Request:
    Our office requires 24-hour notice for prescription refills and/or requests. Special request orders require 7 days' notice.
  • Acts as a digital signature
  • Date Format: MM slash DD slash YYYY