TeleVet Request Form

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

TeleVet Request Form 

Please request an in person appointment or go to the nearest full service or emergency clinic should your pets condition deteriorate.

Telvet services are available for active patients with a current in person exam by Dr. Brown within the last 12 months.

Dr. Brown will respond via email unless a phone call is necessary. Response times vary based on availability and type of response requested. 

Thank you for choosing us for your pet care needs. 

TeleVet Request

Name
First Name
Last Name
Phone
Phone TypePhone Number
Email Address

Pets Name

Please list current diet and all medications/supplements

This condition or concern is

New
Chronic
Unsure


Brief overview of main concerns or questions.

My pet is

Eating normally
Eating less
Not eating


My pet has

Vomiting
Diarrhea
Normal stools
Vomiting & Diarrhea


My pets activity is

Normal
Lethargic
Decreased


My pet is

Breathing normally
Coughing
Sneezing


Please use this for additional space if needed. Be sure to include when concerns started. The more detail the better.

Additional Space if needed.

Pictures and any new medical records or test results are very helpful

Have additional records or pictures been emailed for review to brownvethc@gmail.com

Yes
No


Please choose from the following telemedicine options. Regular business hours are Mon-Fri 9AM to 6PM (required)

STANDARD RESPONSE:$82 for up to 30 min phone or email consult within 1 to 3 business days during regular business hours
SAME DAY RESPONSE:$120 for up to 30 min phone or email consult during regular business hours
PREAPPROVED AFTERHOUR/WEEKEND RESPONSE: includes additional $150 plus SAME DAY fee of $120 for 30 min phone or email consult


By checking this box I understand Dr. Brown will respond to my questions via email within 1 to 3 business days unless a same day response was requested
By checking this box I agree to prepay for televet services 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


By checking this box I understand that if my pets condition can not be addressed via telemedicine or worsens that I must schedule a housecall or Soul Puppy appointment or go to the nearest full service veterinary clinic or emergency clinic
Thank you for choosing Brown Veterinary Services for your pet care needs.


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