Prospective Client Inquiry

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

Colleen Brown DVM-Integrative Veterinarian

Prospective Client-General Inquiry

dogs on computer

Thank you for your inquiry

This form, fee and communication is for general information only that can be found on Dr. Browns sites 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 prior to submitting a new client request 
  • This is not a new client, telehealth or telemedicine request form 
  • Medical questions, treatment plans & prescriptions/herbals are not provided
  • This form, fee & correspondence does not establish a VCPR 
  • All required fields must be filled for form to process.
  • Please email scheduling@brownvetservices.com after form and fee submission to confirm receipt of both
  • Prepayment is required for Dr. Browns time before receiving an email response
  • No refunds, transfers or exchanges
  • Dr. Brown only responds via email and is NOT available via phone

Thank you!

Special Correspondence Form

Date (required) :
Name (required)
First Name (required)
Last Name (required)
Address
Street Address
City
,		State / Province
Zip / Postal Code
City and Major Cross Streets (required)

Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Confirm Email
E-Mail Address (required) :
TeLeVET Response & Fee
Email response within 7 business days (Tues-Fri) excluding holiday/seasonal closures (required)

One Email Response per form $88 (general info only i.e. no patient specific treatment plans, prescriptions/herbal, etc.


Prepayment Required (no refunds/transfers/exchanges) (required)

Zelle via 480-494-6034
Venmo via cmbrowndvm
Paypal direct via drbrown@brownvetservices.com


Which practice branch are you interested? (required)

Brown Veterinary Housecalls
Soul Puppy Holistic Healing
Mobile Equine TCVM Services
Soul Pony Stables


Which appointment type are you considering? (required)

Housecall General Medicine-Wellness & Prevention
Housecall General Medicine-Medical
Housecall TCVM Acupuncture +/- Herbal Medicine/Food Therapy
Housecall- Integratvie (combination of General Medicine & TCVM Acupuncture)
Soul Puppy Holistic Healing- TCVM specialty office in historic downtown Mesa
Quality of Life/Hospice/In Home Euthanasia
Equine Mobile Acupuncture
Soul Pony Stables-Equine TCVM in Mesa


If interested in a housecall, have you reviewed Dr. Browns travel zones? (required)

Yes, I have reviewed Dr. Browns travel zones
No
N/A


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 are not considered pet specific medical advice? (required)

Are there 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 on website that are not considered pet specific medical advice? (required)

What questions would you like Dr. Brown to address before submitting a new client request form that are not considered pet specific medical advice? (required)

Dr. Brown has three very detailed websites. What prompted you to request this prepaid communication prior to deciding to submit a new client request form? (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 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.

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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