Forms

PUEBLO SMALL ANIMAL CLINIC

HEARTWORM TEST WAIVER

Contact Us

Client Name

Phone Number

Address

Pet Name(s)

New Field:

I or designated representative, do hereby certify that I am the owner of the above listed pet.

New Field:

It has been explained to me that both the AVMA and the heartworm preventative drug manufacturers recommend testing for heartworms every year, even if my pet was on constant monthly preventative proper to prescribing heartworm medication.

New Field:

I understand that it is possible for my pet to get heartworms even if they are on a monthly preventative. This can be caused by missing a dose, vomiting up medication unbeknownst to owner, inappropriate dosing or product failure.

New Field:

I understand that giving certain heartworm preventatives to a dog that is positive for heartworms may cause serious illness up to and including death.

New Field

I understand that by not annually testing for heartworms or by purchasing heartworm prevention from the internet, I will void any manufacturers compensation offered for treatment of heartworm disease.

New Field:

I hereby waive the testing process and release the doctor and staff of Pueblo Small Animal Clinic from any and all liability for any reactions from giving heartworm medication to my dog WITHOUT prior testing.