YOUR INFORMATION
First Name
Last Name
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Full Name
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How did you hear about us?
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YOUR PET'S INFORMATION
Pet Name
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Age
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Approximate Weight
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Sex
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Type of pet
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Dog
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Breed
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Primary Health Concern
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Dental
Ears
Eyes
General
Labs & Imaging
Orthopedic
Surgeries
More frequent services
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Dental
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Teeth Cleaning (with possible extractions)
Dental Extractions (without teeth cleaning)
Full Mouth Extractions
Orthodontics
Stomatitis
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Ears
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Ear Hematoma
Ear Infections
TECA Surgery (Total Ear Canal Ablation)
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Eyes
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Cataracts
Cherry Eye
Entropion (eyelid surgery)
Enucleations (eye removal)
Ophthalmology
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General
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Skin Allergies
Euthanasia
Chemotherapy
Endoscopy (exploratory surgery)
Foxtail
Rhinoscopy (nasal diagnostic procedure)
Tumor Removal
IVDD Surgery (to treat rear-leg paralysis)
Spay/Neuter
Wellness Exams
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Labs & Imaging
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Echocardiograms & Ultrasounds (heart conditions)
MRI and CT Scans (advanced imaging)
Cushing's Test
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Orthopedic
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Broken Bone
FHO Surgery (hip dysplasia)
Orthopedic Consultations
Patellar Luxation Surgery (knee injury repair)
TTA/TPLO Surgery (CCL injury repair)
Other
Surgeries
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Urinary Issues and Blockages
Bladder Stone Surgery
Exploratory Surgery/Laparotomy
Intestinal Blockage
Nares Surgery (nasal passage widening)
TECA Surgery (Total Ear Canal Ablation)
Pyometra
Splenectomy
Tail Amputation
Tumor Removal
Other
More Frequent Services
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Chemotherapy
Endoscopy (exploratory surgery)
Foxtail
Rhinoscopy (nasal diagnostic procedure)
Tumor Removal
IVDD Surgery (to treat rear-leg paralysis)
Spay/Neuter
Wellness Exams
Vaccinations
Other
Describe the reason for your pet's vet visit
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(619) 782-4747 | Info@MexiVetExpress.com | www.MexiVetExpress.com
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