TeLEVET Time Remote Support Request

Brown Veterinary Housecalls

Dover
Mesa, AZ 85205

(480)494-6034

www.brownvetservices.com

TeLeVET Time Remote Support Request Form

Remote Patient Care & Owner Support

Remote access to direct communication with Dr. Brown outside of scheduled appointments is billed in 15 min increments at a rate of $50/15min

Excludes initial (complimentary) follow up within two weeks or less of each in-person appointment

TeLeVET Time correspondence is available for active patients only with a current in person exam by Dr. Brown within the last 12 months

Response times vary during regular business hours (Tues-Fri 11AM to 5PM/Closed Sat, Sun, Mon & Holidays). Dr. Brown makes every attempt to respond as soon as possible within 12 to 24 hours however please allow for up to 1 to 3 business days due to the nature of this practice*

Please see concierge services for advanced/custom support options

Dr. Brown will always respond via email unless a phone call is necessary or requested

*IMPORTANT: Please request an in person appointment or go to the nearest full service or emergency clinic should your pets condition deteriorate. This is not an emergency or emergency response service

TeleVet Request

Name

First Name	Last Name

Phone
Phone Type	Phone 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
I have made preapproved arrangements with Dr. Brown for alternative payment via check, cash or cc

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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