Request Heartworm Preventative

Instructions

Complete the following to request additional heartworm preventative. We will mail it out on the following Friday.

If your dog is heartworm negative, you are responsible for providing monthly heartworm preventative as described in the Adoption Contract and Addenda.


If you are entering this on behalf of a fosterer, enter their contact information.

Contact Information
Enter your first name
Enter your Last Name
Use format: user@domain.com
Select the type of requestor you are.


Adopter Heartworm Preventative Request
Enter the heartworm positive dog's name when you adopted them from HADR. If you don't know, enter their current name.
Enter the current weight of the dog so we ship you the correct dosage.

Please send heartworm preventative to me.

Foster Heartworm Preventative Request
Enter the current weight of the dog so we ship you the correct dosage.

Please send heartworm preventative to me.

Signature

By submitting this request, I certify that the above information is true and correct under the penalties of perjury. I will only use the heartworm preventative I receive from HADR on either: heartworm positive dogs I foster for HADR or a heartworm positive dog I adopted from HADR. If I adopted a heartworm positive dog from HADR, I understand that HADR will provide no more than twelve total heartworm preventative treatments and I will be responsible for purchasing heartworm preventative starting at the 13th month pursuant to the Heartworm Positive Contract Addendum.  

If you are using a phone or tablet to complete this application, simply sign your name below. If you are using a computer, use your mouse to write your name below.
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Select today's date

Click submit once. It may take up to 30 seconds for the screen to change. Do not click submit more than once.