Heartworm / Flea & Tick Prevention Request
Tell us about your pet so our veterinary team can approve the right prevention safely.
Your details
Your name
*
Email
*
Phone
*
Shipping address
*
Your pet
Pet name
*
Species
*
Select…
Dog
Cat
Breed
Sex / reproductive status
Select…
Male - intact
Male - neutered
Female - intact
Female - spayed
Age
Current weight (lbs)
*
Prevention is dosed by weight — please be accurate.
Any recent weight change?
Select…
No change
Gained
Lost
What you need
Prevention type requested
*
Heartworm
Flea / Tick
Combined (e.g. Simparica Trio)
Recommend for me
Specific product requested (if any)
Safety screen
Does your pet have any seizure or neurologic history?
*
Select…
No
Yes
Is your pet a herding breed (Collie, Aussie, etc.) or known to be sensitive to ivermectin (MDR1)?
*
Select…
No
Yes
Unsure
Is your pet pregnant, nursing, or used for breeding?
*
Select…
No
Yes
N/A
Current flea/tick product
Any past reactions to preventives?
Other current medications
Your veterinarian
Primary / prescribing vet
*
Clinic phone
Date of your pet's last exam
*
Documents & sign-off
Upload heartworm test result or records (optional)
PDF, JPG or PNG.
I confirm this information is accurate, that my pet is under the care of the veterinarian named above, and I authorize SmartyVets to verify records as needed. I understand prevention is dispensed only after veterinary review and a current heartworm test where required.
*
Type your full name to sign
*
Submit request