west-registration | Veterinary Specialty & Emergency Care

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This phone is my

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Pet's Name

Species

Male/Female

Spayed/Neutered

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Date of birth or approximate age

Reason for today's visit

Regular Veterinarian/Clinic

Layout visit How

Checkboxes

Please understand that we greatly respect the veterinarian-client-patient relationship. We work closely with area veterinarians and are here to assist their clients and patients on an urgent, emergency and specialty basis. For follow ups, medication refills or preventive care, we will refer you back to your regular veterinarian. To protect that relationship with our referring veterinarians, we are unable to see your pets for routine wellness care here or at any Noah’s Animal Hospital location.
By clicking the submit button below, I agree that I am the owner or responsible agent of the above pet and authorize the staff of Veterinary Specialty and Emergency Care to treat this animal. I accept full financial responsibility, which will be paid in full at the time of the release of the animal. In the event of a breach in this provision, I agree that VSEC shall be entitled to all damages, attorney fees and expenses incurred in the collection of my account. I have read and understand this authorization and consent.

Emergency Contact Phone Number