New Client Form

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

New Client-Patient Request Form

Thank you for choosing Brown Veterinary Services for your pet care needs! 


STEP ONE -NEW CLIENT FORM 

  • Please submit the NEW CLIENT REQUEST FORM  below which will be emailed directly to Dr. Brown 
    • All required fields must be filled for processing and a confirmation window will pop up immediately when submitted correctly (you may need to scroll below video to see it). 
    • IMPORTANT: If you do not receive a confirmation window immediately (scroll to see) and email from Dr. Brown or her online assistant Deb within 1-2 business days then the form did not process correctly and your request was not received

STEP TWO -SUBMIT VETERINARY MEDICAL RECORDS

  • Please contact your current/previous veterinary clinic(s) and request the most recent pertinent VETERINARY MEDICAL RECORDS and RABIES VACCINE HISTORY information by email to brownvethc@gmail.com 
  • REVIEW PROCESS
    • Dr. Brown will review information submitted and you will be contacted regarding your request by phone or email by Deb (online assistant) 
      • For safety purposes, Dr. Brown does not accept patients with a history of aggression or in need of sedation for exams

STEP THREE -APPOINTMENT DEPOSIT & DAY/TIME SELECTION 

  • After receiving APPOINTMENT APPROVAL please submit APPOINTMENT DEPOSIT (minimum of $50) via zelle, venmo or paypal. 
  • APPOINTMENT DATE/TIME OPTIONS will be sent via email or phone once deposit is received 
  • FAQ: Can I find out what specific appointment slots are available before submitting a deposit?
    • No, due to the nature of this practice,  it is not possible to offer date/time availability for general inquires as Dr. Brown receives dozens of requests for appointments daily. Her availability is determined by what is already on the schedule and where. This can change quite rapidly due to the logistics of scheduling appointments at different locations throughout the valley.  Her time is divided between traveling for housecalls and appointments at Soul Puppy. Therefore she is only able to see a limited number of patients per day and often has a patient wait list. For this reason available appointment dates and times are only given to serious inquiries only i.e. paid deposits. 
    • Note: Submitting a deposit before or without appointment approval will not guarantee an appointment 

STEP FOUR-APPPOINTMENT CONFIRMATION

  • Appointment date/time CONFIRMATION EMAIL
  • Thank you for adhering to COVID-19 guidelines. Masks continue to be required for all appointments for safety purposes. 
  • 24 HOUR CANELLATION FEE/NO SHOW FEE of $50 

STEP FIVE-SUBMIT PATIENT HISTORY FORM


Please note THIS IS NOT AN EMERGENCY SERVICE, on call or concierge service. 

  • Patients are seen by scheduled appointments only.
  • Regular business hours are Mon-Fri 9AM to 6PM. Appointment hours vary based on availability and location. 
  • If you have an EMERGENCY, please contact the nearest emergency clinic in your area, or call VCA Animal Referral and Emergency Center at 480-898-0001.
  • Examples of emergencies may consist of, but are not limited to, labored breathing, bleeding, active seizure, broken limbs, hit by car, dog fight/open wounds, males cats unable to urinate, etc.
  • If your pet is deceased please contact PALS directly

~Thank you,

Dr. Brown

Deb (online assistant)

Jim (appointment assistant/technician)

 

New Client

Primary Owner Name (required)
First Name (required)
Last Name (required)
Spouse or Secondary Owner Name
First Name
Last Name
Address-please list ONE LOCATION ONLY (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Major Cross Streets

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

Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone
Phone TypePhone Number
Email
Email address (required)

Appointment Type
Selection (required)

Housecall-Western Veterinary Medicine only-Wellness/Prevention/Vaccines, etc.- Starts at $165
Housecall-Western Veterinary Medicine only-Sick/Injured (nonemergency) -Starts at $165
Housecall-Integrative Veterinary Medicine (both Western/TCVM)-Starts at $375
Housecall-TCVM only (Acupuncture, Herbal, Food Therapy) -Starts at $275
Housecall-Quality of Life-In Home Gentle Euthanasia & Cremation Services -$Variable
Equine Acupuncture & Chinese Veterinary Medicine for Horses-Housecall or Barncall- Starts at $350
Soul Puppy Holistic Healing-Mesa TCVM only office -Starts at $187
Telemedicine (active patients only) -Starts at $82/30min


Pet Information
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


Are your pets vaccines current?

Yes
No
Unknown


Do you have your pet(s) medical records?

Yes
No


Please have your pet(s) medical records emailed to brownvethc@gmail.com after submitting this form
By clicking yes, I agree to have my pet(s) medical records and vaccine history emailed for review
Current/Previous Veterinary Practice

Phone number or City and State of previous vet.

I understand that Dr. Brown or her online assistant Deb will contact me via email or phone after receiving this form
Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

How did you hear about our services?

Referral
Ad
Newspaper
Tv
Facebook
Instagram
Other


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
Nature of Service
Thank you for choosing us for your pet care needs. Dr. Brown sees patients by scheduled appointment based on location and availability. Brown Veterinary Housecalls is not an emergency, on-call or 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. Dr. Brown does not respond to text or social media messaging.
Payment is due at time of services rendered by cash or credit card. A minimum deposit of $50 based on appointment type/location is required to hold all appointments. There is a 24 hour $50 cancellation fee.
Aggressive Pet Policy
Aggressive Pet Policy
Safety is important to Dr. Brown. Therefore she 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. By clicking "I Agree" in the section below, you are stating you agree to these terms.
I have read Payment Policy, Cancellation Policy, Nature of Service and Aggressive Pet Policy and agree to the terms. (required)

I Agree
I Disagree


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