Heartworm Waiver

Owner's Name *

First

Last

Email *

Phone *

Pet's Name *

I, the undersigned, owner of the above-named pet, have been informed of the possible risks involved in giving my dog medication to prevent heartworm without first performing a heartworm blood test. I understand that annual heartworm testing is strongly recommended, and I choose not to test at this time. *

I have read and understand

Signature *

Clear Signature

Date *

Heartworm Waiver