You are being asked to sign this waiver because, according to our records, your dog is not currently on a heartworm preventative and/or it has been more than a month since their last negative heartworm test.
You have the option to do a heartworm test the day of surgery, for an additional fee, and waive this form. If you choose this option, please sign here:
I decline a heartworm test for my pet prior to anesthesia; I understand the risks of allowing my pet to be anesthetized without performing a routine blood test to make sure my pet is negative for heartworms prior to anesthesia. If my pet is heartworm positive and is anesthetized a fatal reaction could occur during or after anesthesia resulting in the death of my pet. Many heartworm positive pets do not show any signs or symptoms of this disease at home. I understand these risks and choose to anesthetize my pet without a heartworm test. By signing this waiver I understand the risks involved with anesthetizing my pet without making sure my pet does not have heartworm disease first and I agree not to hold Bethel Community Pet Hospital, LLC or its staff responsible for any side effects brought forth by this decision.
