Please tell us which website you used to access this form as Dr. Brown has three branches to her practice (required)
|
Correct Form Confirmation (required)
|
Owner Verification |
Owner Verification (required)
|
Additional Information if submitting this form for an elderly family member or disabled person
|
Aggressive Pet Policy |
Temperament Disclosure (required)
|
Additional Information regarding your pets temperament
|
General Medicine-Medical (wellness & TCVM not included) |
General Medicine-Medicial Housecall: Includes up to One Hour Total Appointment Time (dogs/cats). Additional Fees Apply for Adjunct/A la Carte Services, extended time/travel. (required)
|
|
|
|
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 |
Email address (required)
|
Pet Information |
Pet #1 Name (required)
|
Type of Pet (required)
|
Age: Years, Months
|
Breed:
|
Color
|
Sex:
|
Neutered/Spayed
|
Is your pet current on vaccines?
|
Does your pet have a history of vaccine reactions?
|
Has your pet had a full blood panel in the past 12 months?
|
Reason for appointment/main concerns (One health concern per request please) (required)
|
Duration of above concerns/conditions
|
Goals of appointment/treatment? (One health concern per request please) (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
|
If your pet on Heartworm prevention?
|
Is your pet on flea/tick prevention?
|
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?
|
My Pets behavior at vet clinics (required)
|
Does your pet have a history of anxiety? (required)
|
Current and/or Previous Veterinary Clinic for medical records and vaccine history
|
Phone number or City and State of previous vet.
|
If Current/Previous Veterinary Clinics your pet has been to for medical record and vaccine history above was left blank please give reason in the space below (required)
|
Special requests or conditions?
|
How did you hear about our services?
|
If referred by an individual, who may we thank for the referral?
|
Additional Pet Information |
Pet #2 Name
|
Type of Pet
|
Additional Pet Information |
Pet #3 Name
|
Type of Pet
|
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. |
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 (for approved requests only notified via email). 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 |
Processing ....
