Decline Heartworm Prevention of Testing

Heartworm Prevention Waiver

Please review the information below and sign the preventive care waiver at the bottom of the screen.

Preventive Care Waiver

I understand that my dog/cat is at risk to contract heartworm disease.
I understand that if heartworm disease is contracted it could be fatal.
I understand that treatment for heartworm disease is not guaranteed and can cost up to $1,000 or more.
My veterinarian recommends year-round heartworm prevention to prevent new infections (does not treat established infections, "adult worms") and annual heartworm testing to detect any established infections.

I hereby decline *

Heartworm Test Heartworm Prevention

I hold both veterinarian and staff harmless should illness, injury, or death result from declining the recommended care.

* Indicates required field

Owner's Name *

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Last

Pet(s) Name *

By typing your name electronically you are agreeing to the statements above and your electronic signature is the legal equivalent of your manual signature. PLEASE TYPE YOUR NAME: *

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Heartworm Prevention Waiver

​Preventive Care Waiver

Preventive Care Waiver