BBR Heart Worm and Flea Prevention Request Form

As a member of the Bama Bully Rescue Family, you are eligible to request your adopted pup's heartworm and flea prevention medications from us for a small donation that covers our cost!

PLEASE ALLOW AT LEAST ONE MONTH'S LEAD TIME TO FULFILL YOUR REQUEST.
 
MEDICATION DESCRIPTION: We offer a compounded, monthly, all-in-one heartworm and flea preventive that is comparable to brand name products like Trifexis and Sentinel, but at a fraction of the cost. Like the brand name products, this medication also protects against intestinal parasites, such as roundworms, hookworms, and whipworms. Please note - This formula does not kill adult fleas, but will disrupt the flea's life cycle so that it cannot reproduce. If your pup already has fleas, please discuss immediate flea remedies with your veterinatian. This medication does not protect against tick bites. We require you to seek your veterinarian's advice on whether this is the best medication for your pet(s). 
 
FUR SIBLINGS: You may also order this medication for your BBR alum's fur siblings. Again, we require that you consult your veterinarian before administering this medication to your non-BBR dogs.
 
SIX MONTH SUPPLY: Compounded medications have a shorter shelf life than some brand name medications. Therefore, we can send you a six-month supply. Please reorder a refill at least one month in advance.

Owner / Foster Information

Dog(s) Information

Enter each dog's name, whether or not you adopted him/her from BBR (YES/NO), current weight in pounds and age in years:
 Dog's NameBBR Alum (Yes/No)Weight in lbsAge in Years
#1
#2
#3
#4
#5
#6
Total Due at Checkout 🛈
$0.00

Veterinarian's Information

Please answer each of the following questions:

1. All dogs listed above are up to date on required vaccinations. *
2. All dogs listed above live with me in my home. *
3. I have consulted my veterinarian about the safety of administering the requested medication to my dog(s). *
4. I hereby release, discharge, and hold harmless BBR and any person, firm, or corporation charged or chargeable with liability, their heirs, administrators, executors, successors, and assigns, from any and all claims, damages, costs, expenses, loss of services, actions, and causes of actions, whether known or unknown, belonging to the me due to use of this medication. *
Please proceed to payment. We will verify your information, and process your request as quickly as possible. The medication will be mailed to you at the address provided above. If there is a problem, we will contact you for additional information, and will refund your donation if we cannot fulfill your request for medication.