Blood Test for Heartworm Medication Form

Please fill out the Blood Test for Heartworm Medication Form below, and a member of our team will get back to you shortly. We look forward to hearing from you! 

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Which hospital is this for?(Required)
Client’s Name(Required)
Consent(Required)
For these reasons,(Required)
I agree to hold the veterinarians and staff at this veterinary practice harmless in the event I purchase heartworm medication and administer it to my pet without the recommended blood test and one or more of these pets subsequently is infected with heartworms or suffers an adverse reaction to the medication.