Bravecto® Quantum Form – Walker Veterinary Hospital

Walker Veterinary Hospital

Bravecto Quantum Suitability Assessment Questionnaire

Bravecto Quantum is an injection that provides flea and tick protection for dogs for 1 year*.

Instructions: Please answer all questions below to determine if Bravecto Quantum is appropriate for your dog.

Basic Eligibility

1. Is your dog younger than 6 months?

Yes = ❌Not eligible

2. Does your dog weigh less than 2.2 pounds?

Yes = ⚠️Requires veterinary consultation

3. Has it been over 6 months since your dog was examined by a veterinarian at our hospital?

Yes = ⚠️Requires veterinary consultation

Medical History

4. Has your dog ever had a seizure or is on anti-seizure medication?

Yes = ⚠️Requires veterinary consultation

5. Has your dog been diagnosed with any neurological disorder (epilepsy, brain tumor, etc.)?

Yes = ⚠️Requires veterinary consultation

6. Has your dog ever experienced tremors or loss of coordination (ataxia)?

Yes = ⚠️Requires veterinary consultation

7. Has your dog ever had an adverse reaction to any flea/tick medication including oral or topical Bravecto?

Yes = ⚠️Requires veterinary consultation

8. Has your dog ever had an allergic reaction (hives, facial swelling, difficulty breathing) to any medication, vaccine, or medical treatment?

Yes = ⚠️Requires veterinary consultation

Current Health

9. Do you have concerns about your dog's current health or medical condition(s)?

Yes = ⚠️Requires veterinary consultation

10. Have there been changes to your dog’s appetite and energy levels recently?

Yes = ⚠️Requires veterinary consultation

Female Reproductive Status

11. Is your dog currently pregnant, nursing, or planned for breeding in the next 12 months?

Yes = ❌Not eligible

Lifestyle & Exposure

12. Does your dog travel to areas where lone star ticks (Amblyomma americanum) are common ie: Midwestern, southeastern, and eastern US?

*Bravecto Quantum is indicated to protect against Amblyomma americanum for 8 months.

Yes = ⚠️Requires veterinary consultation

If you answered ‘yes’ to any above questions, please contact us to schedule an exam to assess and further discuss eligibility.

If you answered ‘no’ to all questions above, please email this completed questionnaire to [email protected] and schedule an appointment for the Bravecto Quantum injection with a veterinary assistant or a veterinary technician.

Owner Certification

I certify that the answers provided above are accurate to my dog’s current health status. I understand the risks and benefits of Bravecto Quantum and waive a full veterinary exam for the purpose of receiving this injection today.

Signature (printed name/sign):

Date:

Testimonial

What They Say

I called Walker Veterinary Hospital at 7:30 in the morning because my fur baby needed an urgent procedure, they fit me in same day within an hour or so of calling and from the moment I walked through those doors I was met with such compassion and kindness. It was such a scary and uncertain time but Dr. Hung and everybody I encountered was kind and knowledgeable and honestly exactly what I needed! My baby is on her road to recovery because of the excellent and timely care she received and I will FOREVER be grateful for them, Doctor called the morning after the procedure to check on her recovery and I just cannot express how much it means to know my girl was in the hands of someone so caring!

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Jenn C

The worst day of our life happened… our boxer Bo’s life came to an end, he was unable to walk anymore. He could barely breathe, and it was time we went to Walker vet, and they took care of things. Someone was really paying attention because they realize the level of grief we were experiencing today in the mail unexpectedly, we received a pair of paw prints Words cannot express how heartfelt this is.

Lauren Johnson
Lauren Johnson

This site saved my dog’s life. My ESA and best friend was limping one day and we went to another site around town, and they prescribed him carprofen. It made things worse. We went to get a second opinion as things worsened at Walker. The doctor walked through symptoms with us, had me feel the lymph nodes in his back leg, and he was diagnosed with Immune-Mediated Hemolytic Anemia (IMHA). We don’t know what caused it but his body was destroying its own red blood cells. After this was identified he was put on steroids and antibiotics and he is in full recovery! He is back to his normal personality. I owe everything to Walker’s staff for saving my buddy.

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Cody Eliff

We visited Walker Vet because we heard Dr. Hung was familiar with FIP in cats. Her knowledge, and her care, put us at ease and saved our cat’s life. She explained the details to us like a friend. She was genuinely concerned about his life, and helping us to build a strong at-home care regimen. The front office staff is professional and friendly. They operate smoothly and support the doctors well. Of my many phone calls, even on very busy days, I never received any attitude. Just good people helping other people and their pets.

R
Randy

My dog has always received the best care from Dr. Connie. My boy can be a handful at times, and Dr. Connie is always very patient with him, as well as with me, in answering all my questions and concerns regarding my fur baby's care. All the staff have always treated us with respect and care. I recommend Wallker Vet, especially Dr. Connie, to all my friends and family! Thank you for all your care, Dr. Connie! We appreciate you.

Jena Hernandez
Jena Hernandez
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