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Neighbourhood Pet Clinic Auto-Order Parasite Prevention Form
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Name
*
First
Last
Email
*
Phone
*
Name of your furry family member:
*
Species:
*
Dog
Cat
Requested Product(s):
*
Nexgard/Nexgard Spectra
Simparica/Simparica Trio
Other (please specify)
Unsure
If Other, please specify:
*
Requested Product(s):
Nexgard Combo
Revolution Plus
Other (please specify)
Unsure
If Other, please specify:
Duration
*
Ongoing (recommended, as fleas and ticks are active year-round)
Until November of this year (end of heartworm risk)
Other
Please note you can cancel or edit your recurring delivery at any time.
If Other, please specify:
*
Do you have another pet to add?
*
Yes
No
Name of your furry family member:
*
Species:
*
Dog
Cat
Requested Product(s):
*
Nexgard/Nexgard Spectra
Simparica/Simparica Trio
Other (please specify)
Unsure
If Other, please specify:
*
Requested Product(s):
Revolution Plus
Other (please specify)
Unsure
Requested not please
If Other, please specify:
*
Duration
*
Ongoing (recommended, as fleas and ticks are active year-round)
Until November of this year (end of heartworm risk)
Other
Please note you can cancel or edit your recurring delivery at any time.
If Other, please specify:
*
Do you have another pet to add?
*
Yes
No
Name of your furry family member:
*
Species:
*
Dog
Cat
Requested Product(s):
*
Nexgard/Nexgard Spectra
Simparica/Simparica Trio
Other (please specify)
Unsure
If Other, please specify:
*
Requested Product(s):
Revolution Plus
Other (please specify)
Unsure
If Other, please specify:
*
Duration
*
Ongoing (recommended, as fleas and ticks are active year-round)
Until November of this year (end of heartworm risk)
Other
Please note you can cancel or edit your recurring delivery at any time.
If Other, please specify:
*
Delivery Instructions/Buzzer Number
*
I acknowledge that this is an enrollment for recurring product delivery and is not intended for one-time or urgent requests. By clicking "Submit", I confirm that my requested product is not needed in the next seven days.
*
I have read and understand
Submit