Heartworm Treatment Request - Legacy Humane Veterinary Clinic

URL

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First Name*

Last Name*

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Service(s) Needed*

3 Shot Treatment

Other

"Other" Treatment Needed:*

Please enter any information related to the surgery and/or additional services you are requesting.

Would you prefer to be contacted via phone or email to schedule your appointment?*

Phone

Your Pet's Name*

Your Pet's Age*

Photo of Your Pet

For the pet's profile.

Max. file size: 10 MB.

Pet's Sex*

Male

Female

Already spayed or neutered?*

Yes

Pet's Breed*

Pet's Weight*

For surgery appointments, your pet will be weighed at the time of surgery. If your pet falls into a larger weight range at the time of surgery, you will be notified before pick-up and will owe the balance at the time of pickup.

Describe your pet's appearance (include specific markings)

Please describe any past/current medical issues your pet has had.

If you are filling out this form for medical assistance other than a routine spay/neuter for your pet, please explain in detail the pet's medical need here. If 'none' then please indicate none.

Is this appointment to get your pet spayed or neutered?*

Yes

Please note that if your pet is in pregnant, in heat or a cryptorchid male at the time of surgery, an additional fee may apply ranging from $10-$40. You will be notified of any additional costs before pick up, with the balance due at the time of picking up your animal.

Dog Neuter Pricing*

Please select the weight range for your pet.

2-25 lbs - $115

26-50 lbs - $125

51-75 lbs - $135

76-100 lbs - $145

Dog Spay Pricing*

Please select the weight range for your pet.

2-25 lbs - $125

26-50 lbs - $145

51-75 lbs - $155

76-100 lbs - $165

Is your pet current on his/her rabies vaccination?

If you answer No, an additional $10 fee will be charged for rabies vaccination unless you can show proof of rabies vaccination at your scheduled spay/neuter appointment.

Yes

Upload medical records including rabies and heartworm test results here:

Drop files here or

Max. file size: 50 MB.

Additional Dog Services, please select any services you would like to add

Rabies - $15

Dappv/L4 - $20

Bordetella - $15

Dog Dewormer - $12-$18 (depending on weight)

Heartworm Test - $20

Heartworm Prevention

Over 200,000 dogs are infected with heartworms each year. Heartworms are spread by mosquitos, and every dog whether indoor or outdoor is at risk if not protected by a monthly heartworm prevention. Without treatment, a heartworm positive dog will die of this disease. Dogs under 7 months of age do not require a heartworm test to purchase heartworm prevention from LHVC during your visit, but dogs 7 months of age and older will require a heartworm test before purchasing heartworm prevention.

Heartworm Purchase*

Yes, I would like to purchase Oral Heartworm Prevention

Yes, I would like to purchase ProHeart12

No thank you

Oral Heartworm Prevention Duration*

6 Month Oral Heartworm Prevention*

1-12lbs - $30

12-25lbs - $35

26-50lbs - $40

51-100lbs - $50

12 Month Oral Heartworm Prevention*

1-12lbs - $60

12-25lbs - $70

26-50lbs - $80

51-100lbs - $100

ProHeart12 Options*

Weight up to 25lbs - $60

26-50lbs - $70

51-75lbs - $80

76-100lbs - $90

101-130lbs - $120

Running Total

Promo Code

All promotions/discounts will be applied when your appointment is confirmed.

Amount Due at Appointment

Required Deposit Upon Submitting Form

On the following page, you'll be prompted to pay at least a $50 deposit to secure your appointment. The $50 will be deducted from your grand total at the time of your appointment. If we are unable to accommodate your pet's needs, the $50 deposit will be refunded to you.

* By hitting submit, you will be able complete the payment of your deposit.

Preferred Appointment Day*

NOTE: Heartworm treatment appointments are only completed on Monday and Tuesdays.

Monday

Tuesday

Preferred Appointment Date*

Please make sure the date occurs on the day of the week chosen above.