Parasite Prevention Questionnaire in Ilderton, ON

Name*

Date

Phone*

Email*

Pet's Name

Are you concerned about tick exposure for your dog?

Yes
No

Does your dog tend to hunt or eat prey (mice, rabbits, other wildlife) or droppings?

Yes
No

Is your dog ever unattended when outside?

Yes
No

Does your dog have any food allergies?

Yes
No

If you answered "YES" to the above question, please specify the allergy.

Were you happy with the prevention you administered last year?

Yes
No

If you answered "NO" to the above question, please specify your reasoning.

Would you prefer to proceed with topical (liquid drops on back) or oral (chew/tablet) prevention this year?

Topical
Oral

Do you have any leftover doses of the prevention you administered last year?

Yes
No

If you answered "YES" to the above question, how many doses and which product?

Is the product still within good expiry to last until the end of this season (November 2023)?

Yes
No

Would you like to pick up the full season at one time?

Yes
No
Undecided

If you answered "NO" to the above question, please tell us how many doses (months) you would like to pick up at one time.

If your pet requires a Heartworm test, or you would like to take advantage of the reduced rates for wellness testing, please select the option you would like to proceed with.

Snap 4DX Test $68 - Tests for Heartworm disease, Ehrlichia, Lyme and Anaplasma (4 blood parasites)
Junior Wellness $115 - 4 blood parasites as above, blood cell counts (CBC) and chemistry panel to check 10 values of internal organ function
Senior Wellness $170 - 4 blood parasites as above, blood cell counts (CBC) and chemistry panel to check 25 values of internal organ function
UNDECIDED
NOT APPLICABLE

Would you like to speak with a technician to review prevention and testing options?

Yes
No

If you answered "YES" to the above question, please list the specific questions you would like answered.

Name

This field is for validation purposes and should be left unchanged.

Parasite Prevention Questionnaire

Mailing Address

Office Hours

Monday	8:30am – 5:00pm
Tuesday	8:30am – 5:00pm
Wednesday	8:30am – 5:00pm
Thursday	8:30am – 5:00pm
Friday	8:30am – 5:00pm
Saturday	8:30am – 12:00pm
Sunday	Closed