SOUTHSIDE PET HOSPITAL
ACCOUNT #__________________ CLIENT NAME:________________
SOUTHSIDE PET HOSPITAL
Parasitic Disease Screen
Why should you have your dog tested?
Ticks and mosquitoes and the diseases they carry can be found throughout
all 50 U.S. states and Canada. And evidence suggests the geographic
distribution of these parasites and the pathogens they carry is also spreading.
Because your dog could be at risk of infection, it's important to know:
• Just one bite from a parasite that's carrying disease can infect your dog.
• Most parasitic diseases show few symptoms; some don't show any.
• Following a prevention plan can help keep your best friend free from parasitic disease
What to watch out for:
Lyme disease Anaplasmosis Ehrlichiosis Heartworm
What can you do?
| | | | | |
|Which parasite carries which|Deer tick or western black |Deer tick or western black |Brown dog tick |Mosquito |
|diseases? |legged tick |legged tick, | | |
| | |Brown dog tick |Lone star tick | |
| | | | |Can cause fever, anorexia, lethargy, |
|What happens if my dog |Often leads to lameness; can|Can lead to lameness and/or |Can result in joint pain and|polyarthritis, lameness, rapidly progressive|
|becomes infected? |result in kidney failure and|breathing disorders |lameness: may affect |renal failure and neurologic syndromes |
| |death | |production of blood cells | |
To provide the best care for your pet, our practice offers one quick, simple test to screen for all of these diseases.
With your consent, we can screen your pet to provide the best possible defense.
Please choose one screening option for your pet:
______Yes, perform the recommended test to screen for all of these diseases.
______ NO, I understand the risks of parasitic diseases, but I would rather not screen for them at this
time.
Pet’s Name _________________________
Client Signature ________________________________________________Date________________
FOR OFFICE USE ONLY:
|LYME |POSITIVE |NEGATIVE |
|ANAPLASMOSIS |POSITIVE |NEGATIVE |
|EHRLICHIOSIS |POSTIVE |NEGATIVE |
|HEARTWORM |POSITIVE |NEGATIVE |
|OWNER NOTIFIED | YES NO |EMAILED |
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