Heartworm Test Decline Form — Daniel Island Animal Hospital

HEARTWORM TEST DECLINATION FORM

Name

First Name

Last Name

Pet's Name

Daniel Island Animal Hospital, The American Heartworm Society, and American Animal Hospital Association (AAHA) recommend annual heartworm testing. It can take up to 6 months for a heartworm test to be positive after a dog’s exposure, so a negative test after a lapse in treatment, or in a young or adopted pet, may not indicate that no infection is present. For this reason, it is important to test again 6 months later. Additionally, it is important to make sure preventative medications are working. While heartworm medication is extremely effective, some pets can still become infected. Why? Perhaps a dose may be missed or late, sometimes a dog can vomit or spit their pills out when owners aren’t looking, or the heartworms develop a resistance to the medication. It is best to diagnose heartworms as soon as possible because they can cause progressive or fatal damage. Dogs who have had a lapse in treatment and have an undetected infection could experience anaphylaxis or clotting after heartworm medication is restarted due to the sudden death of the parasite with prevention medication. This is why we test prior to restarting prevention. I have been informed of the risks of not performing a heartworm test and have decided at this time to decline the recommendations of the doctor/staff. I have been informed that the heartworm test is in the best interest of my pet. Not allowing a heartworm test to be performed could potentially risk his/her health. Signing below will relinquish any/all liability from Daniel Island Animal Hospital and staff.

Date

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