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*
Today's Date

YearMonthDay
Date
Phone Number*
Email*
example@example.com
Patient Details
Pet Name*
Special diet or prescription food?*
Approximate Birthdate*
Approximate Weight*
Male or Female*
Species/Breed*
Is your pet anxious/aggressive?*
Is your pet spayed or neutered?*
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.*
Date of injury or start of symptoms described above*

MonthDayYear
Date
Is this trip primarily for a dental cleaning?*

YesNo
Would you like to choose "Clinic 1" or "Clinic 2" for dental services? (See email for detailed explanation of both)*

Clinic 1 - Light Cleaning (lower cost, no pre-anesthesia blood work option)Clinic 2 - Deep Cleaning (Pre-anesthesia blood work included, higher total cost)No preference/earliest availability
* 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 (no food or water)*
Initial
Is your Pet on any medication?*

YesNo
What is the name of the medication, the dosage, and how long have they been on it?*
Would you like to add

Pathology (applicable when tumors or growths are removed)Blood workFlea medsDewormingAnal gland expressionGrooming (not always available, but we'll try to accommodate!)
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)*

YesNo
If not up to date, which vaccines are we updating today? (Rabies vax required for dogs)*

Rabies (required for dogs if not already up to date)Parvovirus/CoronavirusDistemper/LeptospirosisBordetellaOther
Are you providing MexiVet Express with your pet’s veterinary records? (If so, please upload below)*

YesNo
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
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MexiVet Intake Form

OWNER INFORMATION

Patient Details

HEALTH CONCERNS/SYMPTOMS