Prospective Client Inquiry

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

Colleen Brown DVM-Integrative Veterinarian

Prospective Client-TCVM Inquiry


Cat on computer (paid canva copyright)

Thank you for your inquiry

This form, fee and communication is for general TCVM 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/herbals 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 TCVM request 
  • This is not a new client, telehealth or telemedicine request form 
  • Medical questions, treatment plans & prescriptions/herbs 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!

TCVM Inquiry Form

Date (required) :
Name (required)
First Name (required)
Last Name (required)
Address
Street Address
City
,
State / Province
Zip / Postal Code
Phone (required)
Phone TypePhone Number (required)
Email
E-Mail Address (required) :
Confirm Email
E-Mail Address (required) :
TeLeVET Time Response & Payment
Email Response from Dr. Brown within 7 business days (Tues-Fri) excludes posted holiday/seasonal closures (required)

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


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

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


TCVM CAN BE INTEGRATED INTO EVERY MEDICAL CONDITION INCLUDING WELLNESS & PREVENTION
Information regarding TCVM services, fees, theory, indications, treatment frequency, adjunct services, etc is found in detail on Dr. Browns websites at no cost to you
Have you reviewed the TCVM information available on Dr. Browns site for the practice branch you are considering? (required)

Yes, I have reviewed it
No


ALL TCVM PATIENTS ARE TREATED WITH ACUPUNCTURE
Practice Branch
Which branch of Dr. Browns practice are you considering for TCVM Services? (required)

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


If you answered Brown Veterinary Housecalls, which option are you considering? (required)

TCVM Acupuncture Housecall (no general medicine)
Integrative Housecall (general medicine & TCVM combo)
N/A


If you answered Brown Veterinary Housecalls, have you reviewed Dr. Browns travel area? (required)

Yes, I have reviewed her travel area
No
N/A


If you answered Brown Veterinary Housecalls, in which city do you reside and what are your major cross streets?

TCVM ADJUNCT SERVICES ARE AVAILABLE FOR ACTIVE ACUPUNCTURE PATIENTS ONLY-ADDITIONAL FEES APPLY
Chinese Herbal Veterinary Medicine-Adjunct Service
Chinese Herbal Medicine uses herbal blends to treat TCVM specific diagnostic patterns-tailored to each individual patient. This is a prepaid service for active acupuncture patients only. Additional fees apply.
All TCVM patients are treated with acupuncture. Are you also interested in Chinese Herbal Medicine? (required)

Yes, I am also interested in Chinese Herbal Medicine
Not at this time


TCVM Food Therapy-Adjunct Service
TCVM Food Therapy
Food Therapy involves home cooking via the principles of TCVM and is tailored to each individual patient. This is an adjunct add on service for active acupuncture patients only. Additional fees apply.
All TCVM patients are treated with acupuncture. Are you also interested in TCVM Food Therapy? (required)

Yes, I am also interested in TCVM Food Therapy
Not at this time


What medical conditions does your pet have that you would like addressed with TCVM? (required)

What questions do you have about incorporating TCVM into your pets treatment plan that was not addressed on the website and is not considered pet specific medical advice? (required)

What is it you would like to know before submitting a new client request to potentially work with Dr. Brown for TCVM Services that is not considered pet specific medical advice? (required)

Dr. Brown has three extremely detailed websites that describe her TCVM services in detail. Please explain why you were compelled to request this paid correspondence before submitting a new client request? (required)

By submitting this form you agree to the following checked statements below
By checking this box I understand this service is for general TCVM info only. I understand this is NOT a veterinary medical consult or telemedicine consult and that medical advice or prescriptions/herbals will NOT be given by law
By checking this box I understand this service does NOT establish a Veterinary Client Patient Relationship (VCPR) and that an in person appointment is required by law to establish a VCPR
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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