Request Appointment

If you would like to request an appointment at our hospital, please fill out and submit the form below, or call us at 808-445-3624. Please note that this is only a request, someone from our office will contact you shortly to confirm a date and time for your appointment. If your matter is URGENT, or you feel you are experiencing an EMERGENCY, please call us immediately at 808-445-3624 and DO NOT use the form below.

"*" indicates required fields

Your Name*

First Last

Email*

Phone*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Pet's Name*

Breed*

Pet's Age*

Sex*

Fixed Male

Fixed Female

Unfixed Male

Unfixed Female

Pet's Color*

Requested Appointment Date*

Reason for Appointment*

Phone

This field is for validation purposes and should be left unchanged.

83613

Request Appointment

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