Patient Update & Progress-Active

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

Brown Veterinary Housecalls-Soul Puppy Holistic Healing-Mobile Equine TCVM

Active Patient Update & Progress Form

Doctor and cat icon with heart

Complimentary

  • Two-Week or less Post In-Person Appointment Remote Follow Up 
  • Brief Question* i.e. current medication/herbal dose questions
  • Update Only (response not included)-keep Dr. B informed of patient health status & treatment progress info

Dr. Brown will respond to two-week complimentary follow ups & brief questions via email within 7 business days or sooner pending availability.

If it has been greater than two weeks since your pets most recent in-person appointment and you would like a response from Dr. Brown, please submit an online TeLeVET request form and fee or subscribe to a concierge texting plan. See TeLeVET page for details. Thank you!

Patient Update & Progress Form

VCPR-Veterinarian Client Patient Relationship
My pet is an ACTIVE patient with Dr. Brown via (required)

Brown Veterinary Housecalls
Mobile Equine Acupuncture-TCVM
Soul Puppy Holistic Healing (Mesa specialty office)


My pets most recent exam or acupuncture treatment with Dr. Brown (required)

Two weeks or less (complimentary response)
Monthly Schedule
1 to 3 months
6 to 12months
If greater than 12months your pet no longer has an active VCPR-please submit an in-person appointment request. Thank you


Pet Care Team
Has your pet been seen by another DVM, ER, Urgent Care, Specialist, Chiropractor, Corporate Telemedicine Service, etc. since your most recent appointment with Dr. Brown? (required)

No
Yes-records have been emailed to records@brownvetservices.com
Yes- records have NOT been submitted to records@brownvetservices.com


If yes answered above, please provide additional information (reason for appointment & treatment provided)

Progress Form Details
Purpose of Form Submission (Active Patients Only) (required)

Two-week post in-person appointment complimentary follow up
Update only-no response (i.e. patient health status or treatment progress info to keep Dr. Brown informed)
Quick Question (i.e. current medication or current herbal dosage question, recheck labwork frequency question, etc.)


Name (required)
First Name (required)
Last Name (required)
Phone (required)
Phone TypePhone Number (required)
Email address (required)

Pet Patient Info
Pet Name (required)

Species

Dog
Cat
Horse


Medication
Medications with Doses currently being given (for best service please do not write same as previous) i.e. X amount given X times daily (required)

Chinese Herbal Prescription
Chinese Herbals with Doses currently being given (for best service please do not write same as previous) i.e. X amount given X times daily (required)

Supplements
My pet takes the following supplements (required)

1. None
2. Glucosamine
3. CBD
4.Probiotics
5. Standard Process
6.Nordic Naturals
7.Slippery Elm
8. Other


Additional space for supplement details (please write numbers from above if more than one & provide details if others not listed)

Diet
Current Diet (for best service please do not write same as previous)

Appetite & Gastrointestinal Concerns
Appetite (required)

Normal
Decreased
Increased
Finicky
Nausea


Vomiting (required)

None
Frequent
Vomits Bile
Vomits Food
Regurgitation
Nausea
Occasional


Stools (required)

Normal
Soft
Diarrhea
Constipation
Staining to defecate
Fecal Incontinence
Mucous in stool
Blood in stool
Abdominal pain/Colic-horses
Gastric ulcers-horses


Additional space for Appetite or Gastrointestinal Concerns

Water Consumption and Urinary System
Water Consumption (required)

Normal
Excessive
Not drinking
Unsure


Urination (required)

NormalStraining
Blood in urine
Frequent Urination
Not urinating (if male cat blocked-seek emergency care immediately)
Unsure


Cardiovascular & Respiratory Systems
Heart & Lungs (required)

Normal
Cough
Sneeze
Reverse Sneeze
Heart murmur-stable
Congestive heart failure-stable
Respiratory distress (please seek emergency care immdiately)
Exercise intolerance
Asthma history-stable
Asthma history-flare up (please seek emergency care immediately)


Skin & Ears
Allergies (required)

None
History of allergies-stable
History of allergies-flare up
Licks feet
Uticaria/Hives-horses


Level of Itchiness (required)

None
Mild
Mod
Severe
Licks feet only


Ears (required)

No concerns
Shaking head
Scratching ears
Odor
Swollen ear flap (hematoma)
Red & Inflammed ear
Chronic otitis-stable
Chronic otitis-flare up


Additional space for Allergy & Otitis (ear) concerns

Neurology
Nervous System (required)

Normal
Seizure-first ever: please seek emergency care immediately
Seizure history-recent episode
Seizure history-stable
Head tilt
Circling
Paralysis/Paresis-new-please seek emergency care immediately
Paralysis/paresis-stable/responding to treatment
Wobblers


Additional space for nervous system concerns

Musculoskeletal System
Musculoskeletal (required)

Normal
Limping
Hindend Weakness
Swollen leg or joint
Tendon/Ligament Injury
Arthritis
Hoof abscess-horses
Back pain-horses
Laminitis-acute
Laminitis-chronic
Navicular
Shoulder pain-horses


Additional space for musculoskeletal concerns

Update & Progress Information (please be as specific as possible to avoid back & forth communication)

Questions or concerns for Dr. Brown relating to your pets most recent appointment (Please submit a TeLeVET Time form for new concerns or requests)

Additional Space/Quick Question(s)

Complimentary Follow Up (within 2 weeks of in person appointment date): Dr. Brown will respond via email within 7 business days
Patient Updates only (response not included however Dr. B. may suggest an in person appointment or TeLeVET Time based on information provided)
Quick Question (yes/no or brief response): Dr. B will respond within 7 business days. If more involved than yes/no or brief response TeLeVET Fees apply

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Thank you for your referrals!

Family owned & operated since 2010

 

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Soul Puppy Holistic Healing Button

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Thank you for your referrals!

Family owned & operated since 2010

 

TeLeVET Button

House Calls Button

Equine Acupuncture Button

Soul Puppy Holistic Healing Button

In Home Euthanasia button