Prescription

Heartworm Questionnaire!

We've got to ask you a couple of questions to ensure that heartworm prevention is safe for your dog. Once our vet has vet through (get it?) your form, we'll arrange for your order to be sent to you!
Your Name*
Phone Number*
Email Address*
Your Pet's Name*
Pet's Weight*
Do you have a ZumVet account?*

NoYes
Is your pet suffering from any other health issues?*

YesNo
What health issue does your pet have and is any treatment being given ?
We will need to verify with our ZumVet that {yourPets} is suitable to continue on heartworm prevention.

As a gentle reminder, ZumVet recommends that you continue to follow up with your vet on your pet’s health condition. This can help to minimise the risk of disease progression, which can sometimes increase the side effects from taking a heartworm preventative.
When was your last visit to a vet?

within the past 1 yearMore than 1 year ago
Is this the first time your pet is taking heartworm prevention?

YesNo
What type of heartworm prevention is your pet taking?

My pet is on a monthly oral heartworm medicationMy pet is on a yearly heartworm injection (Proheart)
How old was your dog when the heartworm injection was LAST given?

Younger than 1 year oldOlder than one year old
When was the heartworm injection last given?
How old is your dog?

younger than 6 months oldolder than 6 months old
Has your pet skipped any doses of its heartworm medication?

YesNo
Has your pet been taking heartworm medication every month?

YesNo, sometimes I skip a few months
Important!

1. Even if your pet has been on regular heartworm prevention (and all doses have been administered on schedule). we still recommend for your pet to have a yearly veterinary physical examination.

2. The American Heartworm Society recommends year-round heartworm prevention, as does ZumVet.

3. It is recommended that dogs on year-round heartworm prevention be tested annually for the presence of heartworm larvae or antibodies, even if no doses have been skipped. This is to check for preventative-resistant heartworms

4. It is also recommended to test your pet for heartworm before switching from one brand of heartworm preventative to another.

5. ZumVet has the right to reject your prescription request and/or recommend a video call/heartworm test on medical grounds, if the veterinarian sees the need to do so.

6. If your dog is below 1 years old and the last heartworm prevention it received was SR-12(Proheart), you will be unable to purchase Heartworm prevention from ZumVet and should seek advice from your usual veterinarian instead.

7. Please note that the safety of the product has not been evaluated for pregnant/lactating animals.

8. By purchasing heartworm prevention from us, you agree that you have been the legal owner of your pet for at least 2 weeks, and you have observed your pet to be well for at least 2 weeks.
By purchasing Nexgard Spectra from us, you agree and understand that:*

You have not missed a dose before the last 2 months. It is dangerous to restart your pet on heartworm prevention without a heartworm test if it has been 6 months or more since you last fed the heartworm prevention. If you initially started heartworm prevention in a dog > 6 months old before doing a heartworm test, you should do a heartworm test before continuing heartworm prevention.
In the event that you are not sure if your pet should continue on heartworm prevention, we recommend speaking to one of our ZumVets via a Video Call.
I, {yourName}, the undersigned owner or agent for the owner of the pet named {yourPets}, declare that the information I have provided is accurate. I agree to not hold ZumVet responsible in the event heartworm medication is purchased and administered, and {yourPets} subsequently acquires heartworm or suffers an adverse reaction to the medication.*

I have read and understood the above, and I agree.I declare that my pet does not have a history of seizures. I declare that my pet is not pregnant, lactating or breeding.
Signature*

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Heartworm Questionnaire!