RESCUE - HEARTWORM TREATMENT

Rescue Name*

Dog Name*

Email for medical records to be sent*

example@example.com

Medical approval number*

Please enter a valid phone number.Format: (000) 000-0000.

Foster's Name*

Foster phone number*

Please enter a valid phone number.Format: (000) 000-0000.

What heartworm treatment is this?*

HEARTWORM TREATMENT CONTINUATION RELEASE
Consent form required: CLICK HERE

Why Sedation May Be Necessary

The injections used for heartworm treatment are administered deep into the epaxial (lumbar) muscles, which are located immediately adjacent to the spine. This area is sensitive, and the depth of the injection can make the process uncomfortable. As a result, some dogs may become tense, reactive, or guarded during handling. Any sudden movement at the time of injection can increase the risk of improper placement, worsen pain, and contribute to additional muscle inflammation. Sedation helps minimize stress, prevents unexpected movement during and after the injection, and significantly improves overall comfort and safety for the patient.

If necessary, do you approve sedation?

Has this dog ever experienced any adverse reactions during or after a sedated procedure in the past?

What adverse reactions occurred during/after a sedated procedure

Please list any medications, supplements, topical treatments your pet has received in the past 72 hours and when they were last given: If none have been given please state none.

Are there any known health concerns and/or chronic disease or conditions?

While my pet is sedated, I request the following add-ons to be performed. These will be added to the final invoice:*

If your pet becomes nauseous, do you give CHEW permission to give an anti-nausea medication (cerenia) *

In the event of an unforeseen emergency, we will make every effort to contact you promptly. Please be assured that we take all necessary precautions to ensure your pet is safe and in good health before proceeding with their scheduled procedure. Any known risks will be thoroughly discussed with you in advance. However, on rare occasions, emergencies can occur, and we ask that you indicate your preference in the event that we are unable to reach you. Please select your preference below:*

Please proceed with basic cardiopulmonary resuscitation (CPR). I accept responsibility for all costs incurred (starting at $175).Please do not proceed with basic cardiopulmonary resuscitation (CPR). I accept responsibility for all costs incurred.

MORE INFORMATION

Heartworm Treatment at CHEW: READ MORE
Please administer gabapentin and prednisone prior to arrival at CHEW between 7:00–8:00 AM. If you do not have these medications, please notify the nurse at drop-off so they can be administered at that time.
Drop-off by 8:30 AM. Pickup time is 4:00 PM unless otherwise noted.
If boarding overnight for the 3rd injection, please bring their own food.