Complete the following to provide the results of the heartworm test.
By submitting this request, I certify that the above information is true and correct under the penalties of perjury.
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.
Click submit once. It may take up to 30 seconds for the screen to change. Do not click submit more than once.