Determine a Window of Infection

This Window of Infection is for*

Dog’s date of birth*

Patient Record Number*

How many dogs live in this home including this one?*

Fields marked with * are mandatory

Test
results

Date

Result

Date	Result

Enter all heartworm preventive purchases for at least 2 years prior to the last negative test.

Date

Doses in pack

# of dogs using pack

Date	# of doses	# of dogs

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More info

Window of
Infection

Date of preventive
purchase

Administration of
doses

Prevention gap