Prospective Client Inquiry

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

Brown Veterinary Housecalls

Prospective Client Special Correspondence Request Form

Thank you for your inquiry

This form, fee and communication is for general information only that can be found on this site at no cost and does not create a Veterinarian Client Patient Relationship (VCPR) i.e. medical advice, treatment plans and prescriptions are not included nor does this guarantee new client approval if a request is or has been submitted

Created for pet parents that wish to "interview" or "chat" with Dr. Brown
This is not a new client, telehealth or telemedicine request form
Medical questions, treatment plans & prescriptions are not provided
This form, fee & correspondence does not establish a VCPR
All required fields must be filled for form to process
No refunds or transfers

Thank you!

Special Correspondence Form

Please tell us which of Dr. Browns websites you were reviewing as there are three branches to her practice (required)

Brownvetservices.com (main site-housecalls)
Soulpuppy.net (TCVM office in downtown Mesa)
Drbrownequineacupuncture.com (mobile equine TCVM services)

What type of appointment are you considering? (required)

Housecall General Medicine-Wellness & Prevention
Housecall General Medicine-Medical
Housecall TCVM- Acupuncture +/- Herbal Medicine/Food Therapy
Housecall- Integratvie
Soul Puppy Holistic Healing- TCVM specialty office in historic downtown Mesa
Quality of Life/Hospice/In Home Euthanasia
Equine Mobile Acupuncture
Virtual Consult/Telehealth/Telemedicine-under construction for new clients

Please choose from the following options. NO REFUNDS OR TRANSFERS (required)

Complimentary Email response from remote reception within 7 business days excluding holiday closures
Prepaid Chat with technician for $88/15min during regular business hours within 7 business days excluding holiday closures (no refunds/transfers)
Prepaid Email Communication from Dr. Brown within 7 business days during regular business hours excluding holiday closures $111 for 15 min (no refunds/transfers)
Prepaid Phone Communication with Dr. Brown within 7 business days during regular business hours excluding holiday closures $200 for 15 min (no refunds/transfers)

Name (required)

First Name (required)	Last Name (required)

Phone (required)
Phone Type	Phone Number (required)

Email Address (required)

City and major cross streets (travel area) Please give full address if requesting quote estimate (required)

Pets Name (required)

Species of Pet named above (required)

Dog
Cat
Horse

Breed of Pet named above (required)

Age of Pet named above in years (required)

Brief pet history and medical conditions of concern for which you are considering an appointment with Dr. Brown (required)

What questions do you have about the type of appointment you are considering above for your pet THAT IS NOT CONSIDERED PET SPECIFIC MEDICAL ADVICE? (required)

General Questions that you were not able to find answers to on website THAT ARE NOT CONSIDERED PET SPECIFIC MEDICAL ADVICE? (required)

What specific questions do you have that were not answered upon review of website or unable to find on website THAT ARE NOT CONSIDERED PET SPECIFIC MEDICAL ADVICE? (required)

Additional Space if needed

Additional Space if needed.

By checking this box I understand that this service is for general information only. I understand this is not a veterinary medical consult or telemedicine consult and that medical advice will not be obtained by law

By checking this box I understand that this service does not establish an active client/patient/doctor relationship and that an actual in person physical exam appointment with my pet is required to do so by law

I understand by checking this box that if not requesting a complimentary email that this is a prepaid nonrefundable fee for a one time correspondence service for general information and that general information can be found on this site at no cost

I understand by checking this box that this fee will not count toward any other services, is not the same as an appointment deposit and that this correspondence service and fee will not guarantee a future appointment with Dr. Brown

By checking this box I agree to prepay for this correspondence service via zelle, venmo or paypal. I understand that due to the number of requests received daily that Dr. Brown will not be able to respond to my request until payment is received.

Preferred payment options. NO REFUNDS OR TRANSFERS (required)

Complimentary Response Requested
Zelle-send to 480-494-6034 or brownvethc@gmail.com
Paypal-send to drbrown@brownvetservices.com
Venmo-send to cmbrowndvm

A portion of this fee will go to NOTONEMOREVET: an organization that helps veterinary professionals cope with the demands of the profession in dealing with compassion fatigue and suicide risk.

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Thank you for your referrals!

Family owned & operated since 2010