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Canine Lyme Disease Risk Assessment Form

Complete the canine Lyme disease risk assessment form to evaluate your dog’s risk and take preventive measures at Northwood Animal Hospital.

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Canine Lyme Disease Risk Assessment Form

Please ensure accurate completion of the canine Lyme disease risk assessment form for a thorough evaluation of your dog’s risk factors.

Canine Lyme Disease Risk Assessment Form

(1 Form per Pet. Dog Owners Only)

In Guilford County, one out of every 28 dogs tested positive for Lyme disease in 2018*. Fill out the questionnaire below to help determine if your dog may be at increased risk for contracting Lyme disease.

Check a YES or NO box as it best applies to you:

If you answered Yes to any of the above questions, then your dog is at increased risk for contracting Lyme disease. At a minimum, your dog needs to be on a tick preventative year-round. In addition, the Lyme disease vaccination can provide your dog with additional protection from Lyme disease. A technician or veterinarian will discuss the Lyme disease vaccination with you during today’s visit.

Data from the Companion Animal Parasite Council website, www.petsandparasites.org

Please note that this vaccine costs $38, and requires a 2nd booster 3 weeks after the initial booster.

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