MexiVet Intake Form

MexiVet Intake Form

Please provide the following information on you and your pet so we can make sure to give you both the best possible care!
OWNER INFORMATION
Full Name
Phone Number
Format: 1-000-000-0000.
Today's Date

YearMonthDay
Date
Are you new to MexiVet Express?
Email
example@example.com
Patient Details
Pet Name
Is this pet new to MexiVet Express or possibly visiting a new vet clinic this trip?
Male or Female
Is your pet spayed or neutered?
Approximate Birthdate
Approximate Weight
Species/Breed
Is your pet anxious/aggressive?
Special diet or prescription food?
Does your pet have a microchip?
A microchip is required for re-entry to the U.S. and can be administered at the vet clinic in Mexico if your dog does not already have one. Cats are not required to be microchipped.
HEALTH CONCERNS/SYMPTOMS
Describe the reason for your pet's vet visit, your main concerns & symptoms, onset, diagnoses, duration, etc.
Is this trip primarily for a dental cleaning?
Would you like to choose "Option 1" or "Option 2" for dental services? (See email for detailed explanation of both)
* Please note, sedated teeth cleanings can involve extractions of loose or damaged teeth. The cost of extractions is not included in the teeth cleaning price estimate.
I understand that appointments involving anesthesia and/or blood work require 10 hours of fasting from food.
Initial
Is your Pet on any medication?
What is the name of the medication, the dosage, and how long have they been on it?
Would you like to add
Please describe the grooming you would like (bath, haircut, haircut-length, etc.)
Groomers will do their best to accommodate, however results are not guaranteed.
Please provide a photo example of the type of haircut you would like for your pet.

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Are the vaccines up to date? (If so, please upload below)
If not up to date, which vaccines are we updating today? (Rabies vax required for dogs)

Other
Are you providing MexiVet Express with your pet’s veterinary records? (If so, please upload below)
Please upload vaccination records and medical documents related to this vet visit (videos are ok too!)

Rabies vaccination is required for dogs to re-enter to the US. If you have a dog riding with us and you don't have a rabies certificate, we can have the vaccine updated during their appointment.
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Lastly, please give us a recent picture of your pet! (If you haven't already)

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(619) 782-4747 | Info@MexiVetExpress.com | www.MexiVetExpress.com
ADMIN: Client Status
ADMIN: Clinic
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ADMIN: Appointment Date & Time
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MexiVet Intake Form

OWNER INFORMATION

Patient Details

HEALTH CONCERNS/SYMPTOMS