Registration Form

I authorize and direct the veterinarians at Noe’s Ark to diagnose, prescribe, perform therapeutic procedures, and/or surgery that their judgment may dictate to be advisable for the patient’s well-being. NO warranty or guarantee has been made as to the result or cure. Noe’s Ark is not a 24-hour facility. (I have read and understand)

In the event any balance due hereunder is not paid as agreed, the undersigned jointly and severally agree to pay all costs including said unpaid balance, interest accrued, and including a reasonable collection and/or attorney’s fees. (I have read and understand)

I authorize Noe’s Ark to take my credit card number over the phone to pay for any refills needed. I understand once processed, my credit card number and associated numbers will be shredded. (I have read and understand)

Noe’s Ark requests you give us 24 hours’ notice of cancellation of your appointment so we may offer the time to another client. If this notice is not given or you do not show up for your scheduled appointment, a $74 fee may be charged to your account. This will need to be paid as well as a prepaid exam when you schedule your next appointment. (I have read and understand.)