Wow that is a lot! Is this an older dog? If under 5 years they usually don't do bloodwork. Hmmm... I understand doing a heartworm test but that is like $35... Anyway, sorry to hear it cost so much. I personally would skip all those dewormers...a once a month dewormer sounds like they gave your triflexis which is known to have killed dogs
And then if you live in an area that is high risk for heartworm in the warm months then just give heartworm pills in the warm months. And flea/tick meds....well, I don't use those either as they are poison lol! I just prefer to take a more natural approach and it turns out to be much cheaper.
Just trying to help you save money! I fostered a shelter dog recenty and it was $50 for a exam and spay surgery.... That is kind of weird that the shelter didnt give you an exam/shots and neuter voucher...most of them do.