Pre-Appointment Correspondence Request

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

PRE-APPOINTMENT

CORRESPONDENCE

REQUEST FORM

for

Brown Veterinary Housecalls Soul Puppy Holistic Healing Equine Acupuncture-TCVM

THANK YOU FOR YOUR INQUIRY

FOR YOUR CONVENIENCE, ALL GENERAL INQUIRY QUESTIONS ARE ANSWERED DIRECTLY ON DR. BROWNS WEBSITES AS SHE IS EITHER WITH A PATIENT OR TRAVELING

THIS SMALL BUSINESS MOBILE SPECIATLY PRACTICE DOES NOT HAVE A RECEPTION STAFF ON DEMAND. PLEASE UTILIZE DR. BROWNS SITES FOR BEST SERVICE

YOU ARE CURRENTLY ON DR BROWNS MAIN SITE WHICH CONTAINS INFORMATION & LINKS TO ALL THREE BRANCHES OF PRACTICE

HOUSECALLS

General Medicine, Traditional Chinese Veterinary Medicine, Integrative Medicine, In Home Euthanasia & more

brownvetservices.com

EQUINE MOBILE TCVM SPECIALTY SERVICES

drbrownequineacupuncture.com

DOWNTOWN MESA TCVM SPECIALTY OFFICE

soulpuppy.net

PLEASE REVIEW THE LINKS BELOW & OTHER DETAILED INFORMATION ON THIS SITE BEFORE SUBMITTING THIS FORM

RESPONDING TO QUESTIONS THAT HAVE ANSWERS AVAILABLE ON THIS SITE TAKES AWAY FROM APPOINTMENT AVAILABILITY & PATIENT CARE

NEW CLIENT PAGE

SERVICE OVERVIEW

FAQ

QUESTIONS BEYOND GENERAL INQUIRIES ARE CONSIDERED MEDICAL ADVICE & REQUIRE AN APPOINTMENT. FOR EXAMPLE, IF YOU WOULD LIKE TO KNOW HOW EXACTLY DR BROWN CAN HELP YOUR PET, THAT IS AN EXAMPLE OF A PET SPECIFIC MEDICAL QUESTION THAT REQUIRES AN APPOINTMENT

THANK YOU

#NOTONEMOREVET

Please note Dr. Brown is not able to offer free consults, medical advice or personally respond to general inquiries or requests for interviews or chats prior to scheduling

This is not a new client request, telehealth or telemedicine request form

ALL REQUIRED FIELDS MUST BE FILLED FOR FORM TO PROCESS

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-(no acupuncture)
Housecall TCVM Acupuncture & Chinese Medicine (no general medicine)
Housecall Integratvie (both general & TCVM)
Soul Puppy Holistic Healing TCVM specialty office in historic downtown Mesa (no general medicine)
Quality of Life/Hospice/In Home Euthanasia
Equine Mobile Acupuncture

Please choose from the following options. Regular business hours are Tues-Fri 11AM to 5PM CLOSED Sat, Sun, Mon & Holidays (required)

Complimentary Email response from remote support
Prepaid Chat with technician for $44/15min during regular business hours within 1 to 3 business days
Email response from Dr. Brown within 1 to 3 business days during regular business hours $88 for 15 min
Phone response with Dr. Brown within 1 to 3 business days during regular business hours $111 for 15 min

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) (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? (required)

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

What specific questions do you have that were not answered upon review of website or unable to find on website THAT IS NOT CONSIDERED 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 (required)

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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