Please tell us which website you used to access this form as Dr. Brown has three branches to her practice (required) Brown Veterinary Housecalls: Brownvetservices.com Soul Puppy Holistic Healing: Soulpuppy.net Equine Acupuncture-TCVM: Drbrownequineacupuncture.com Correct form confirmation (required) I am interested in a TCVM Acupuncture appointment for my dog or cat at Soul Puppy Holistic Healing in downtown Mesa-please continue I am interested in a housecall appointment-please stop and submit housecall request form available on this main site Confirmation of understanding of available Soul Puppy Services (required) I understand Soul Puppy is a TCVM only office , that my pet will be treated with acupuncture & additional fees apply for herbal medicine/food therapy service & treatment options. I also understand this is not a full service clinic & that general medicine is not available at Soul Puppy I am not interested in acupuncture for my pet-PLEASE STOP HERE
Owner Verification (required) I am 18 years or older, the rightful owner of the pets listed below, responsible for medical decisions and financial payment of services rendered, who will be present for the appointment if the request is approved I am submitting this form on behalf of an elderly family member or disabled person & will list contact information FOR ALL PERSONS INVOLVED & will give more details in dialogue box below Additional Information if submitting this form for an elderly family member or disabled person
Aggressive Pet Policy
Temperament Disclosure (required) My pet has a history of aggression and needs to be sedated with injectable medication in order to be examined or treated-PLEASE STOP HERE Injectable Sedation has been recommended by my regular vet for my pet in order to be examined or treated-PLEASE STOP HERE My pet has Fear Aggression-I understand my pet may be accepted under terms of probation or not at all pending review My pet is a Fear Biter-I understand my pet may be accepted on probation or not at all pending review My pet has no temperament concerns that I am aware of Additional Information regarding your pets temperament
Soul Puppy Holistic Healing (Mesa TCVM Specialty Office) Note: General medicine is not available at this location-this is not a housecall
Soul Puppy Appointment Service Options-Up to One Hour Total Appointment Time (dogs/cats) (required) Soul Puppy w/ Acupuncture-starts at $237 Soul Puppy w/ Acupuncture & Chinese Herbal Medicine-starts at $417 Soul Puppy Holistic Healing w/ Acupuncture, Herbal Medicine & TCVM Specific Basic Food Therapy -starts at $467 Major Cross Streets (required) Complex or Community Name Building Number or Letter Apartment or Unit Number or Letter Gate Code if applicable Horse Barn or Stable Address and Name
Email address (required)
Pet #1 Name (required) Type of Pet (required) Canine Feline Equine Age: Years, Months Breed: Color Sex: Male Female Neutered/Spayed Intact Neutered Spayed Mare Gelding Stallion Is your pet current on vaccines? Yes No Not sure Rabies only I no longer vaccinate my pet My pet has never been vaccinated I prefer vaccine titers Does your pet have a history of vaccine reactions? Yes No Not sure Has your pet had a full blood panel in the past 12 months? Yes No My pet has never had labwork Reason for appointment/main concerns (required) Duration of above concerns/conditions Goals of appointment/treatment? (required) Please list any history of chronic medical conditions. Please list any previous surgery or dental procedures along with approx age or year of last procedure My pet eats the following diet Commercial diet Raw diet Homecooked diet Hay Other If your pet on Heartworm prevention? Yes No Not applicable What is heartworm? Is your pet on flea/tick prevention? Yes No Please list all medications your pet is currently taking Please list any herbs, supplements, CBD/Hemp etc that your pet is currently taking Does your pet have a history of valley fever? Yes No Never been tested Currently being treated What is valley fever? My Pets behavior at vet clinics (required) My pet needs to be muzzled at the vet office in order to be examined or treated My pet is always muzzed at the vet office as a precaution My pet may need to be muzzled My pet does best in the exam room with me My pet does best when taken out of the exam room away from me My pet takes oral medication prior to vet visits Oral medication taken prior to vet visits has been recommeded for my pet My pet has no temperament concerns that I am aware of Does your pet have a history of anxiety? (required) My pet is taking behavior modification prescription medication My pet is working with a board certified behavorialist My pet is working with a trainer My pet has firework anxiety My pet has storm phobia I think my pet may have anxiety My pet has anxiety that is not the same as Fear Aggression or Fear Biting My pet has separation anxiety My pet does not have a history of anxiety to the best of my knowledge Current/Previous Veterinary Practice Phone number or City and State of previous vet. Special requests or conditions? How did you hear about our services? Referral Ad Newspaper Facebook Instagram Other Internet search Nextdoor Google Event Rescue Cozy Couch Directory Local Vet Clinic My pets veterinarian
If referred by an individual, who may we thank for the referral?
Additional Pet Information
Pet #2 Name Type of Pet Canine Feline Equine
Additional Pet Information
Pet #3 Name Type of Pet Canine Feline
NATURE OF SERVICE
Dr. Brown sees patients by scheduled appointment only during regular business hours based on location and availability. Please note this is not an emergency, on-call or overall concierge service. Due to the nature of this service and territory covered, it is recommended that all pet owners be familiar with local vets and emergency clinics in their area should the need arise. Concierge service options available via paid membership packages on a case by case basis pending availability. Soul Puppy is a TCVM specialty office and is not a full service clinic.
A minimum deposit of $50 per pet is required to confirm all appointments which will be deducted from the invoice total. Payment is due at time of services rendered via cash, credit card, zelle or venmo. There is a $25 48 h notice cancellation fee, $50 24 hour notice cancellation fee, $100 same day cancellation fee if less than 12 hours notice (prepaid acupuncture packages automatically forfeit a treatment visit) and a $200 minimum no show/not home fee including forfeit of any prepaid urgent care/emergency/extended travel fees & deposits (prepaid acupuncture packages automatically forfeit a treatment visit).
AGGRESSIVE PET POLICY
For safety purposes Dr. Brown has a no aggressive pet policy. She reserves the right to decline a physical exam if a pet displays aggressive behavior, such as growling, snarling, lunging or attempting to bite. If the pet is deemed to be aggressive by the veterinarian, the client agrees to pay in full, the house call and travel fee and a veterinarian consultation fee. Dr. Brown does not accept pets with a history of aggression or in need of sedation for exams. Dr. Brown reserves the right to refuse service at her discretion.
Dr. Brown and staff are happy to assist you and your pet in a mutually enjoyable and respectful working relationship with healthy boundaries as outlined on this website. Dr. Brown is a proud supporter of NOTONEMOREVET and reserves the right to refuse service at her discretion.
DIRECT CORRESPONDENCE WITH DR. BROWN
Direct correspondence with Dr. Brown is available via In Person Appointments, TeLeVET Time Remote Support Services & Concierge Package Services. TeLeVET fees apply after initial complimentary follow up per In Person Appointment. Please note unlimited direct correspondence with Dr. Brown via email/phone/text is not included once an appointment has ended. Please request TeLeVET Time for continued support. Online forms & email is the preferred method of communication due to the nature of this practice. Active clients will receive a private number for complimentary text scheduling. This number is for scheduling purposes only (no medical texts please). Thank you
PRACTICED POLICY AGREEMENT
I have read the Deposit/Payment/Cancellation, Nature of Service, Correspondence with Dr. Brown, Aggressive Pet and Client Policy and agree to the terms. (required) I Agree I Disagree I understand that I will receive an email from firstname.lastname@example.org regarding my appointment request within 1 to 3 business days otherwise this form did not process correctly and we did not receive it. All required fields must be entered. I understand I must contact my current/previous veterinarian directly and have my pet(s) medical records & vaccine history emailed to email@example.com for review. Please note requests are waitlisted until records received. IMPORTANT: Submitting this form completes step one (new client form). Please immediately go to step two (medical records). Requests are wait listed until medical records (step two) are received for review. Please respond to our emails for best service.
Complete the verification below