Heartworm Prevention Waiver

Our policy is the administration of monthly heartworm preventative and yearly testing for all dogs. Heartworm disease is a SERIOUS and potentially FATAL disease that can affect dogs and cats.

• Heartworms reside within large vessels of the heart and lungs.
• This parasite can cause serious and PERMANENT damage to the circulatory and respiratory systems.
• Congestive heart failure, breathing problems, and death are also symptoms caused by heartworm disease.
• A SIMPLE, once monthly dosing (or six month injection) of a heartworm preventative can prevent heartworm disease.

• Even if your pet receives a monthly heartworm preventative, it is still important to test every year, since no medication is 100% affective.
• These preventatives can cause a life-threatening reaction if given to a pet that has heartworms.
• The manufacturers of preventatives will only guarantee their products if your pet has a medical history that includes yearly heartworm tests and history of purchasing heartworm preventatives from a licensed veterinarian.

If after reading the information, you still elect to purchase heartworm preventative without a yearly heartworm test, please read and sign below.

By signing this waiver, I, as named below, the owner or authorized agent of the owner, understand all risks involved with declining a heartworm test. Furthermore, I agree not to hold Animal Care Center or Pet Care Center responsible for any side effects brought forth from this medication, for my pet acquiring heartworm disease, or problems associated with heartworm disease, including death.