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My understanding is that you need to have them tested for heartworms before starting the preventative or the dog has to be under six months old. The reason being, if a dog has heartworm disease already and you dose them with the preventive, there can be serious consequences.
My vet doesn't require a visit just to get the preventive, if the dog(s) are already taking it. Once Jax and the kittys get their rabies this month, which we will have done at the vet instead of the rabies clinic because we prefer it that way, they will all be done for a year. Then we won't need to visit the vet again until Kane is due for his yearly rabies in April, 2011. We'll just stop by and pick up some iverhart as needed.
We've never had to spend more than $125 at our vet and that's taking both dogs and both cats in, including their meds.
ETA: Something else I just thought of. If you do decide to try this product nuheart, be sure and verify that its obtained from US sources. The dosing and/or ingredients isn't always correct in foreign products (read:China). What a tragedy it would be to lose a beautiful dog that you thought was protected, only to find out the medication was worthless.
Yes. If by chance you missed a few months or your dog, unbeknownst to you, puked up the pill behind the sofa a few months in a row (unlikely, I know) and your dog DOES have heartworms, and you give the pill, there can be a massive die off of worms that could kill your dog. The vets are covering their butts, as well as trying to be as safe as possible with your dog.