Brown Veterinary Housecalls

3735 E. Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

New Client/Patient Request Form.

  • Thank you for your form submission. A confirmation will post immediately when completed. All required fields must be filled for form to process which will be emailed directly to Dr. Brown. 
  • This form is used for scheduling HOUSECALLS, BARN-CALLS (Equine Acupuncture) or Dr. Browns TCVM-only holistic practice located in downtown Mesa called SOUL PUPPY HOLISTIC HEALING (soulpuppy.net). 

  • Please note that submitting this form does not guarantee an appointment. Due to the nature of a housecall, appointments are scheduled upon review of new client/patient form, vaccine history and medical records for safety purposes. Aggressive patients, patients in need of sedation for exams or lack of previous rabies vaccine history excluding new puppies will NOT be accepted. 

  • Patients are seen by scheduled appointments only. This is not an emergency, on call or concierge service. 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, etc. 

~Thank you, Dr. Brown 

New Client

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

Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone
Phone TypePhone Number
Email
E-Mail Address (required) :
Appointment Type
Type of appointment requested (required)

Western Vet Med/Wellness Housecall
TCVM(acupuncture,herbal,food therapy) Housecall
Quality of Life Housecall
Soul Puppy Holistic Healing Room located in downtown Mesa (TCVM only)


Pet Information
Pet #1 Name (required)

Type of Pet (required)

Canine
Feline
Equine (TCVM only)


Age: Years, Months

Breed:

Sex: (required)

Male
Female


Neutered/Spayed (required)

Neutered
Spayed
Mare
Gelding
Stallion


Are your pets vaccines current? (required)

Yes
No
Unknown


Do you have your pet(s) medical records? (required)

Yes
No


Please have your pet(s) medical records emailed to brownvethc@gmail.com or soulpuppyhealing@gmail.com prior to your appointment
By clicking yes, I agree to have my pet(s) records emailed prior to appointment.
Name of Current/Previous Veterinary Practice (required)

Phone number or City and State of previous vet.

Check the box if you would you like us to call you for your appointment
Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

How did you hear about our services? (required)

Referral
Ad
Newspaper
Tv
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 (TCVM only)


Additional Pet Information
Pet #3 Name

Type of Pet

Canine
Feline


Nature of Service
Nature of Service
Patients are seen by appointment only, subject to 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.
Payment is due at time of services rendered by cash or credit card.
Aggressive Pet Policy
Aggressive Pet Policy
Safety is important to Dr. Brown. Therefore she reserves the right to decline a physical exam if a pet displays aggressive behavior, such as growling, snarling, 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, Nature of Service and Aggressive Pet Policy and agree to the terms. (required)

I Agree
I Disagree



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Colleen Brown DVM

Integrative Veterinarian

(480) 494-6034

Brownvethc@gmail.com  

Phoenix, Arizona


Mesa, Gilbert, Tempe, Chandler, Scottsdale, Fountain Hills, Paradise Valley.

(Extended service area considered/subject to availability/additional fees apply) 

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