TeleVet Request Form

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

TeleVet Time Request Form 

Please use this form for requests for direct correspondence with Dr. Brown or requests for Dr. Browns time for remote patient care outside of in person appointment time


TeleVet Time fees apply for remote patient care and correspondence with Dr. Brown outside of in person appointment time. Dr. Brown bills for her time and expertise outside of in person appointment time in 15 min increments at a rate of $50/15min. 

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

Response times vary during regular business hours and may take 1 to 3 business day due to the nature of this practice. Dr. Brown will respond via email unless a phone call is necessary.


One complimentary supportive follow-up correspondence with Dr. Brown is available for active patients within one month of appointment date


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

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


By checking this box I understand Dr. Brown will respond to my questions via email within 1 to 3 business days.
By checking this box I understand Dr. Brown bills for her time and expertise outside of in person appointment time in 15 minute increments at a rate of $50/15 min.
By checking this box I agree to prepay for the first 15 min. I also agree to pay for any additional time needed and invoiced.
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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