The North Carolina Veterinary Board requires BOTH annual exams and heartworm checks before we can dispense heartworm prevention. After these are done, we can dispense heartworm medication for that pet for 12 months. The same holds true in order for us to dispense ANY medication for your pet. By law, we must do an annual examination (and in some cases blood work) in order to refill medications such as antibiotics, thyroid medications,ear medications, or arthritis medications. Please understand that we have to abide by these regulations, and that this is really for the benefit of your pet.