PREVENTATIVE CARE WAIVER

PREVENTATIVE CARE WAIVER
Please check off to acknowledge:*

I understand that my dog/cat is at risk to contract heartworm disease.I understand that if heartworm disease is contracted it could be fatal.I understand that treatment for heartworm disease is not guaranteed and can cost up to $2,000 or more.
My veterinarian's recommendation is yearly testing and monthly prevention.
I hereby decline:*

Heartworm testHeartworm preventative
I hold the veterinarian, staff, and Pennsauken Animal Hospital harmless should illness, injury, or death result from declining the recommended care.
Pet Name*
Veterinarian*
Pet Owner's Name*

First NameLast Name
Pet Owner's Signature *

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Date*

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