heartworm waiver 3 Heartworm Waiver Please enable JavaScript in your browser to complete this form.Owner's Name *FirstLastEmail *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 understandSignature *Clear SignatureDate *Submit