Patient Update & Progress-Active

BROWN VETERINARY

HOUSECALLS

Valley Wide

EQUINE

MOBILE ACUPUNCTURE

Valley Wide

SOUL PUPPY

HOLISTIC HEALING

Downtown Mesa

BROWN VETERINARY HOUSECALLS

Local Independent Private Practice

COLLEEN BROWN DVM

BY APPOINTMENT ONLY

No Emergencies

Closed Sat, Sun, Mon, All Holidays

EMERGENCY RESOURCES

#NOTONEMOREVET

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

Active Patient Treatment Update & Progress Form

Complimentary Follow Up

Please submit this form within two weeks of your pets in person appointment to receive one complimentary post appointment email follow up from Dr. Brown

Patient Progress Updates

Unlimited patient update forms may be submitted to keep Dr. Brown informed of patient status (response not included). An in person appointment or TeLeVET Time may be recommended based on information provided

Additional Communication & Support

Please submit a TeLeVET Time request form for additional responses, new concerns, Telehealth/Telemedicine, etc.

TeLeVET fees & restrictions apply

Thank you!

ACTIVE Patient Progress Form

My pet is an ACTIVE patient with Dr. Brown via (required)

Brown Veterinary Housecalls
Equine Acupuncture-TCVM
Soul Puppy Holistic Healing

My pets MOST RECENT exam or acupuncture treatment WITH DR. BROWN (required)

Two weeks or less (complimentary response)
Monthly
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

Purpose of form submission (required)

Complimentary post appointment email follow up
Patient treatment progress update only (no response)

Name (required)

First Name (required)	Last Name (required)

Phone (required)
Phone Type	Phone Number (required)

Email address (required)

Patient Name (required)

Species

Dog
Cat
Horse

Current Medications and doses (required)

Current Herbals and doses (required)

Appetite or Gastrointestinal Concerns

Update & Progress Information (please be as specific as possible)

Questions or concerns for Dr. Brown relating to most recent appointment (televet fees apply for new concerns)

Additional Space

I would like to schedule an in-person appointment for my pet

Yes (please text the complimentary scheduling line at 480-648-4401)
My pet is already on the books
Not at this time

My pet is a TCVM Acupuncture patient. I would like to request Chinese Herbal Medicine: Herbal Profile with Prescription (prepaid service) THIS IS NOT AN IN PERSON APPOINTMENT

Yes, please invoice me
No
My pet is not a TCVM patient

My pet is a TCVM Acupuncture patient. I would like to request TCVM Food Therapy-Basic (prepaid service) THIS IS NOT AN IN PERSON APPOINTMENT

Yes, please invoice me
No
My pet is not a TCVM patient

My pet is a TCVM Acupuncture patient. I would like to request TCVM Food Therapy-Custom (prepaid service) THIS IS NOT AN IN PERSON APPOINTMENT

Yes, please invoice me
No
My pet is not a TCVM patient

Complimentary Follow Up: I understand I will receive a complimentary email follow up from Dr. Brown within 7 business days if it has been TWO WEEKS OR LESS since my pets in person appointment

Status Updates only: I understand this is an update and progress form only and does not include a response from Dr. Brown.

Additional Support: I understand a TeLeVET Time request form and TeLeVET fee is required for additional communication support if it has been GREATER THAN TWO WEEKS since my pets most recent in person appointment

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Thank you for your referrals!

Family owned & operated since 2010