New Patient Form

Thank you for visiting our hospital. We look forward to getting to know you and your pet. Please help us to provide the best care possible for your pet by taking a moment to fill out this form.

Client / Owner Information

We will gladly prepare a written estimate if you desire. Please ask the receptionist or doctor. PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED

We accept VISA, MASTERCARD, DISCOVER, AMERICAN EXPRESS, CASH, AND CARE CREDIT. If you plan to use a credit card or Care Credit, please provide your driver’s license to the receptionist to make a copy.

Spouse / Co-Owner Information
Emergency Contact
How did you hear about us?
Doctor Referral
If you have been referred to us by another veterinarian, please provide their information below.
Please tell us about your pet(s)
Please tell us about your pet(s)

To prevent the spread of infectious diseases and parasites, hospitalized and boarded animals must be current on all vaccines and free of internal and external parasites to enter our hospital for surgery, boarding, drop off or hospitalization.

I authorize Haines Road and EDGE Animal Hospital to use my pet’s pictures on social media.

I authorize Haines Road and EDGE Animal Hospital to release my pet’s records to other vets, boarding facilities, etc.

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.