2024 Parasite Prevention Questionnaire – Technician Appointment

This is a technician appointment to collect a blood sample for heartworm and wellness testing only. If your pet has health issues that you would like addressed you will need to schedule a regular appointment with one of our veterinarians to discuss your concerns.*

Acknowledged

Owner's Name

Name*

First Last

Co-owner's Name

Name

First Last

Primary Phone*

Primary phone type

Mobile Phone
Land Line

Email*

Enter Email Confirm Email

First pet's name*

At the bottom of this form there is an opportunity to answer specific questions with regards to your additional pet’s testing and prevention needs

Is your pet having any unusual coughing or sneezing?*

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Has your pet had any recent or ongoing issues with vomiting and/or diarrhea?*

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Is your pet showing any signs that they are feeling unwell?*

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Bloodwork testing questions

What are your normal summer activities with your pet? (check all that apply)*

Select All
Camping
Visiting a cottage? If so, where is it located? (please fill in answer below)
Hiking different trails or walking in wooded areas
Travel outside of the London area? If so, where do you travel? (please fill in answer below)
None of the above

Where is the cottage located?

Where do you normally travel?

Where do you regularly walk your dog? (check all that apply)*

Select All
Sidewalks
Parks with maintained lawns
Hiking trails
Fields or meadows
Wooded areas
Other

Please specify

Do you know where the heartworm hotspots are in the province?*

Yes
No

The heartworm endemic area is in southern Ontario with the risk of infection greatest south of and/or around the 403/402/401 highways that run between Sarnia and Hamilton. This is where 80% of all the Ontario cases occur. The overall prevalence of heartworm in Ontario dogs appears to be approximately 0.5%. However, in a few discrete areas within southern Ontario the prevalence of infection in dogs not on a heartworm preventive can be as high as 5% to 10%. (Excerpt from the Canadian Parasitology Expert panel Guidelines - https://research-groups.usask.ca/cpep/parasitedata/ontario.php)*

Acknowledged

Do you know where the tick hotspots are in the province?*

Yes
No

The range of I. scapularis (Blacklegged or deer tick) is progressively extending northward and along the coasts of Lake Ontario and Lake Erie (Nelder et al 2014). The current risk map shows areas of risk throughout eastern Ontario, in addition to the endemic foci of Point Pelee, Rondeau, Grand Bend, Long Point, Turkey Point, Prince Edward County, and the Thousand Islands. (Excerpt from the Canadian Parasitology Expert panel Guidelines - https://research-groups.usask.ca/cpep/parasitedata/ontario.php)*

Acknowledged

During heartworm season, discounts are available for wellness testing when combined with 4DX heartworm and tick borne disease testing, making it a great time to have your pet’s complete bloodwork checked. A cost savings of approximately $50 is automatically applied to each 4DX testing panel from April 15- June 30th to make testing more affordable. Many factors should be considered when deciding which bloodwork panel is best for your pet including age and health status. The following few questions will guide you through the process of selecting the type of bloodwork testing you would like for your pet.*

Acknowledged

When was the last time your pet had wellness blood work performed?*

less than 1 year ago
1-2 years ago
greater than 2 years ago
don't remember

What is the age and/or needs of your pet?*

<2 years of age with no health concerns - We recommend having wellness bloodwork done once during their first two years of life to check for any congenital concerns that may be hidden from view.
2-9 years of age with no health concerns - We recommend basic wellness testing every other year to allow us to establish baseline values for your pet to identify what is “normal” for them when they are in good health. Changes to these values allow us to detect processes in the body that may not be physically apparent but may be indicators for disease processes.
9+ years of age - We recommend annual wellness testing to monitor for any changes in your pet's overall health. This testing allows us to assess liver and kidney function, electrolyte status and hormone levels, and for any signs of anemia, infection or inflammation. Changes in your pet's bloodwork may allow for early detection of processes in the body that may not be physically apparent but are indicators of possible health concerns.

Is your pet on regular/long term medication(s) like thyroid or pain medication?*

Yes
No

If your pet is on routine medication we recommend regular testing to monitor for adverse effects from the medication and to allow for early detection of conditions that may preclude the ongoing use of that medication. Your veterinary team will help recommend the frequency of testing for your pet but a minimum of annual testing is recommended.

Acknowledged

Has your pet had changes in previous blood work that needs monitoring?*

Yes
No
I don't know

The cost savings available on heartworm and wellness testing during spring make it an ideal time to consider checking your pet's bloodwork.*

Acknowledged

Available Testing Panels:*

4DX - SCREENS FOR HEARTWORM AND 3 TICK-BORNE DISEASES. - Recommended annually for all dogs regardless of their prevention status. Early identification of a heartworm infection before it develops into disease plays a huge role in treatment of this potentially fatal disease. Testing should be done prior to starting prevention medication for the season. Relative pricing $
4DXW - 4DX and BASIC WELLNESS PROFILE - Recommended screening for dogs <1 year to 9 years of age with no ongoing health concern. May also be used for monitoring certain health concerns when recommended by your veterinarian. Relative pricing $$
4DXWT - 4DX and COMPLETE WELLNESS AND FREE T4 SCREEN - Recommended for dogs 2-9 years of age with new or ongoing health concerns or for dogs 9+ years of age. Tests for additional bloodwork parameters as well as basic thyroid function. Relative pricing $$$
Please recommend a panel for me

Is your dog due for a DAP (Distemper, Adenovirus and Parvovirus) booster in the next 3 months?*

Yes
No
I don't know

Are you interested in titer testing instead of vaccinating for DAP?*

Yes
No
I would like information on titer testing

Would you like to add a DAP titer test for this pet today?*

Yes
No

If your pet is due for a DAP booster titer, testing is an option to consider. Titer testing measures the level of antibodies in the blood against a specific virus like Distemper virus, Adenovirus or Parvovirus. These levels correlate well with protective immunity and it is proven that dogs often maintain immunity longer than the normal vaccine intervals for these core viruses. Titer testing will determine if your dog is protected against these viruses or if a vaccine booster is recommended at this time.*

Acknowledged

If your pet is due for a DAP booster, titer testing is an option to consider. Titer testing measures the level of antibodies in the blood against a specific virus like Distemper virus, Adenovirus or Parvovirus. These levels correlate well with protective immunity and it is proven that dogs often maintain immunity longer than the normal vaccine intervals for these core viruses. Titer testing will determine if your dog is protected against these viruses or if a vaccine booster is recommended at this time.*

Acknowledged

Would you like to add a DAP titer test for this pet today?*

Yes
No

If due, would you like to add a DAP titer test for this pet today?*

Yes
No

Parasite prevention

Did you know that tick preventative medications do not always protect your dog against tick borne diseases? Tick preventative medications work through the transmission of medication from the pet to the tick when it attaches and feeds. Nexgard/Nexgard Spectra has a label claim for reduction of Lyme disease as it works to kill the tick before the infection can be transmitted. Some other tick-borne diseases are transmitted earlier in the feeding cycle so infection may occur before the tick dies. These diseases are not currently common in this geographical area.*

Acknowledged

Are you aware of the FDA warning for Flea and Tick Preventative medications containing the Isoxazoline class of drugs?*

Yes
No

Isoxazoline based products have been associated with adverse neurologic reactions including muscle tremors, ataxia and seizures in dogs and cats. These side effects may occur in animals without a prior history of neurologic conditions. Products containing this type of drug include Nexgard/Nexgard Spectra, Bravecto/Bravecto Plus, Credelio/Credelio Plus, Simparica/Simparica Trio and Revolution Plus. Please go to the following website for more information - https://www.fda.gov/animal-veterinary/animal-health-literacy/fact-sheet-pet-owners-and-veterinarians-about-potential-adverse-events-associated-isoxazoline-flea.*

Acknowledged

Other Options for Tick Prevention – Methods of tick control that can be used along with oral or topical products include daily tick checks and removal of ticks and repellent sprays, including essential oil sprays. These may not be as effective as the modern tick preventatives. An Essential Oil Recipe can be found in our Parasite Prevention Library or you can purchase a ready-made product from us.*

Acknowledged

Are you comfortable removing ticks?*

Yes
No

You can find some helpful information in our article “How to Inspect and Remove Ticks from your Dog” found in our Parasite Prevention Library

Acknowledged

Our Parasite Prevention Library contains articles and information on Heartworm, Fleas, Ticks, and Intestinal parasites. We recommend you use these resources if you have questions or would like more information on any of these topics, and to help you make an informed decision on prevention products. https://mainstreetvetservices.ca/parasite-prevention-library-2023/

Acknowledged

MAIN STREET VET PRODUCT CHOICES for this year:

Please choose one of the following Preventative products:*

I do not plan on using a prevention product
INTERCEPTOR - ORAL PRODUCT FOR HEARTWORM and 3 INTESTINAL PARASITES (roundworms, hookworms and whipworms) - Relative price $$
INTERCEPTOR PLUS – ORAL PRODUCT FOR HEARTWORM and 4 INTESTINAL PARASITES (roundworms, hookworms, whipworms and tapeworms) – Relative price $$
REVOLUTION – TOPICAL PRODUCT FOR HEARTWORM AND FLEAS (WEAK PREVENTION FOR TICKS) - Relative price - $$$$
CREDELIO - ORAL PRODUCT FOR FLEAS AND TICKS - NO PREVENTION FOR HEARTWORM - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$
NEXGARD - ORAL PRODUCT FOR FLEAS AND TICKS - NO PREVENTION FOR HEARTWORM - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$
CREDELIO PLUS - ORAL PRODUCT FOR HEARTWORM, FLEAS AND TICKS - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$$
NEXGARD SPECTRA - ORAL PRODUCT FOR HEARTWORM, FLEAS AND TICKS - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$$

We recommend using milk thistle for 7 days after each dose of any type of preventative medication. It is a strong antioxidant that can help support the liver in processing these monthly medications. Would you like to add this to your health care plan?*

Yes
No

Additional Pets

I have additional pets in the household that are scheduled for heartworm testing on the same day.

No
Yes

Second pet's name

Is your pet having any unusual coughing or sneezing?*

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Has your pet had any recent or ongoing issues with vomiting and/or diarrhea?

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Is your pet showing any signs that they are feeling unwell?*

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Available Testing Panels:*

4DX - SCREENS FOR HEARTWORM AND 3 TICK-BORNE DISEASES. - Recommended annually for all dogs regardless of their prevention status. Early identification of a heartworm infection before it develops into disease plays a huge role in treatment of this potentially fatal disease. Testing should be done prior to starting prevention medication for the season. Relative pricing $
4DXW - 4DX and BASIC WELLNESS PROFILE - Recommended screening for dogs <1 year to 9 years of age with no ongoing health concern. May also be used for monitoring certain health concerns when recommended by your veterinarian. Relative pricing $$
4DXWT - 4DX and COMPLETE WELLNESS AND FREE T4 SCREEN - Recommended for dogs 2-9 years of age with new or ongoing health concerns or for dogs 9+ years of age. Tests for additional bloodwork parameters as well as basic thyroid function. Relative pricing $$$
Please select a panel for me

Is this dog due for a DAP (Distemper, Adenovirus and Parvovirus) booster in the next 3 months?*

Yes
No
I don't know

If your pet is due for a DAP booster, titer testing is an option to consider. Titer testing measures the level of antibodies in the blood against a specific virus like Distemper virus, Adenovirus or Parvovirus. These levels correlate well with protective immunity and it is proven that dogs often maintain immunity longer than the normal vaccine intervals for these core viruses. Titer testing will determine if your dog is protected against these viruses or if a vaccine booster is recommended at this time.*

Acknowledged

If due, would you like to add a DAP titer test for this pet today?*

Yes
No

Are you interested in titer testing instead of vaccinating for DAP?*

Yes
No

Would you like to add a DAP titer test for this pet today?*

Yes
No

Please choose one of the following Preventative products:*

I do not plan on using a prevention product
INTERCEPTOR - ORAL PRODUCT FOR HEARTWORM and 3 INTESTINAL PARASITES (roundworms, hookworms and whipworms) - Relative price $$
INTERCEPTOR PLUS – ORAL PRODUCT FOR HEARTWORM and 4 INTESTINAL PARASITES (roundworms, hookworms, whipworms and tapeworms) – Relative price $$
REVOLUTION – TOPICAL PRODUCT FOR HEARTWORM AND FLEAS (WEAK PREVENTION FOR TICKS) - Relative price - $$$$
CREDELIO - ORAL PRODUCT FOR FLEAS AND TICKS - NO PREVENTION FOR HEARTWORM - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$
NEXGARD - ORAL PRODUCT FOR FLEAS AND TICKS - NO PREVENTION FOR HEARTWORM - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$
CREDELIO PLUS - ORAL PRODUCT FOR HEARTWORM, FLEAS AND TICKS - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$$
NEXGARD SPECTRA - ORAL PRODUCT FOR HEARTWORM, FLEAS AND TICKS - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$$

Would you like to add Milk Thistle to your health care plan for this pet?

Yes
No

I would like to add an third pet.

Yes
No

Third pet's name

Is this pet having any unusual coughing or sneezing?

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Has your pet had any recent or ongoing issues with vomiting and/or diarrhea?

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Is your pet showing any signs that they are feeling unwell?*

Yes
No

If so, please note this is a blood collection appointment and you will need to schedule a separate veterinary appointment to have this issue addressed.

Acknowledged

Available Testing Panels:*

4DX - SCREENS FOR HEARTWORM AND 3 TICK-BORNE DISEASES. - Recommended annually for all dogs regardless of their prevention status. Early identification of a heartworm infection before it develops into disease plays a huge role in treatment of this potentially fatal disease. Testing should be done prior to starting prevention medication for the season. Relative pricing $
4DXW - 4DX and BASIC WELLNESS PROFILE - Recommended screening for dogs <1 year to 9 years of age with no ongoing health concern. May also be used for monitoring certain health concerns when recommended by your veterinarian. Relative pricing $$
4DXWT - 4DX and COMPLETE WELLNESS AND FREE T4 SCREEN - Recommended for dogs 2-9 years of age with new or ongoing health concerns or for dogs 9+ years of age. Tests for additional bloodwork parameters as well as basic thyroid function. Relative pricing $$$
Please select a panel for me

Is this dog due for a DAP (Distemper, Adenovirus and Parvovirus) booster in the next 3 months?*

Yes
No
I don't know

Are you interested in titer testing instead of vaccinating for DAP?*

Yes
No

Would you like to add a DAP titer test for this pet today?*

Yes
No

If your pet is due for a DAP booster, titer testing is an option to consider. Titer testing measures the level of antibodies in the blood against a specific virus like Distemper virus, Adenovirus or Parvovirus. These levels correlate well with protective immunity and it is proven that dogs often maintain immunity longer than the normal vaccine intervals for these core viruses. Titer testing will determine if your dog is protected against these viruses or if a vaccine booster is recommended at this time.*

Acknowledged

If due, would you like to add a DAP titer test for this pet today?*

Yes
No

Please choose one of the following Preventative products:*

I do not plan on using a prevention product
INTERCEPTOR - ORAL PRODUCT FOR HEARTWORM and 3 INTESTINAL PARASITES (roundworms, hookworms and whipworms) - Relative price $$
INTERCEPTOR PLUS – ORAL PRODUCT FOR HEARTWORM and 4 INTESTINAL PARASITES (roundworms, hookworms, whipworms and tapeworms) – Relative price $$
REVOLUTION – TOPICAL PRODUCT FOR HEARTWORM AND FLEAS (WEAK PREVENTION FOR TICKS) - Relative price - $$$$
CREDELIO - ORAL PRODUCT FOR FLEAS AND TICKS - NO PREVENTION FOR HEARTWORM - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$
NEXGARD - ORAL PRODUCT FOR FLEAS AND TICKS - NO PREVENTION FOR HEARTWORM - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$
CREDELIO PLUS - ORAL PRODUCT FOR HEARTWORM, FLEAS AND TICKS - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$$
NEXGARD SPECTRA - ORAL PRODUCT FOR HEARTWORM, FLEAS AND TICKS - This product contains the Isoxazoline class of drugs that has been associated with seizures and neurologic events. Relative price - $$$$

Would you like to add Milk Thistle to your health care plan for this pet?

Yes
No