Traditional Chinese Veterinary Medicine (Acupuncture, Herbal Medicine, Food Therapy)
Soul Puppy Holistic Healing (downtown Mesa) Service Options (required) Owner Verification
Owner Verification (required) Additional Information if submitting this form for an elderly family member or disabled person Aggressive Pet & Sedation Disclosure
Temperament Disclosure (required) Additional Information regarding your pets temperament Email (please list one only)
Email address (required) Pet Information (One pet per form and per appointment)
Pet Name (required) Species of pet (required) Age of pet in years Breed: Color Sex: Neutered/Spayed Is your pet current on vaccines? Has your pet had a full blood panel in the past 12 months? Indications for TCVM
Main reason for starting TCVM (required) TCVM Five Element Constition-please choose the one that best fits your pet
My pets personality is most likely (required) My pet has the following Imbalance(s)-please choose the one that most fits your pets current condition or history (required) What is your pets most common temperture preference? (required) 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 My pet eats the following diet (required) Please list your pets current medications Please list your pet current supplements (herbs, cbd, etc) Does your pet have a history of valley fever? My Pets behavior at vet clinics (required) Does your pet have a history of anxiety? (required) Name of Veterinary Practice Medical Records will be emailed from (Dr. Brown only evaluates requests that provide required medical records) Phone number or email of vet clinics that will be sending records (it is the pet owners responsibility to contact clinics and release this information to Dr. Brown via records@brownvetservices.com) How did you hear about Soul Puppy? Who may we thank for your referral? NATURE OF SERVICE
Soul Puppy is a TCVM specialty office offering TCVM specific services only. All patients are treated with Acupuncture. Additional fees apply for herbal medicine & food therapy and are available for acupuncture patients only. Dr. Brown is at this location by appointment only. Patients are seen by scheduled appointment during regular business hours based on availability. This is not an emergency service, walk in or full service clinic. General Medicine is not available at Soul Puppy. It is recommended that all patients continue a VCPR with a full service clinic in their area. DEPOSITS/PAYMENTS/CANCELLATION POLICIES
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. CLIENT POLICY
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 understand that I will receive an email from scheduling@brownvetservices.com 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 records@brownvetservices.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
Selection : a b c
Processing ....
Active Patient Progress Form