Heartworm Decline Form

Please make sure that all boxes are checked before continuing.
By signing this form, I understand the complications of declining heartworm testing as provided to me by the staff members at Animal Hospital of Lake Villa and still choose to decline to test. I am aware of the complications of using monthly or yearly heartworm prevention without an annual check for heartworms. I hold both veterinarians and staff harmless should illness, injury or death result from declining the recommended care.

Animal Hospital of Lake Villa
101 S. Milwaukee Ave.
Lake Villa, IL 60046

Phone: (847) 356-8387
Text: (847) 356-8387
Fax: (847) 356-2817

Premier Veterinary Group
Emergency: (847) 548-5300

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