PREVENTATIVE CARE WAIVER
Please check off to acknowledge:
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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:
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Heartworm test
Heartworm preventative
I hold the veterinarian, staff, and Pennsauken Animal Hospital harmless should illness, injury, or death result from declining the recommended care.
Pet Name
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Veterinarian
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Pet Owner's Name
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First Name
Last Name
Pet Owner's Signature
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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