Please tell us which website you used to access this form as Dr. Brown has three branches to her practice (required) Brown Veterinary Housecalls: Brownvetservices.com Soul Puppy Holistic Healing: Soulpuppy.net Equine Acupuncture-TCVM: Drbrownequineacupuncture.com Correct Form Confirmation (required) My pet has no current health concerns at this time. I am interested in a General Medicine Wellness & Prevention Housecall for my dog or cat. I understand this is not an Integrative or TCVM appointment-please proceed I am not interested in General Medicine-please stop and review other options on new client resource pageOwner Verification
Owner Verification (required) I am 18 years or older, the rightful owner of the pets listed below, responsible for medical decisions and financial payment of services rendered, who will be present for the appointment if the request is approved I am submitting this form on behalf of an elderly family member or disabled person & will list contact information FOR ALL PERSONS INVOLVED & will give more details in dialogue box below Additional Information if submitting this form for an elderly family member or disabled person Aggressive Pet Policy
Temperament Disclosure (required) My pet has a history of aggression and needs to be sedated with injectable medication in order to be examined or treated-PLEASE STOP HERE Injectable Sedation has been recommended by my regular vet for my pet in order to be examined or treated-PLEASE STOP HERE My pet has Fear Aggression-I understand my pet may be accepted under terms of probation or not at all pending review My pet is a Fear Biter-I understand my pet may be accepted on probation or not at all pending review My pet has no temperament concerns that I am aware ofAdditional Information regarding your pets temperament General Medicine-Wellness Housecall (wellness & prevention only-no health concerns please-TCVM not included)
General Medicine-Wellness Housecall: Includes Up to One Hour Total Appointment Time (dogs/cats). Additional Fees Apply for Adjunct/A la Carte Services, extended time/travel, etc. (required) Wellness & Prevention General Medicine Housecall (no health concerns)- Exam/Consult/Base Travel-starts at $199 Major Cross Streets (required) Complex or Community Name Building Number or Letter Apartment or Unit Number or Letter Gate Code if applicable Email
Email address (required) Pet Information
Pet #1 Name (required) Type of Pet (required) Canine FelineAge: Years, Months Breed: Color Sex: Male FemaleNeutered/Spayed Intact Neutered SpayedIs your pet current on vaccines? Yes No Not sure Rabies only I no longer vaccinate my pet My pet has never been vaccinated I prefer vaccine titersDoes your pet have a history of vaccine reactions? Yes No Not sureHas your pet had a full blood panel in the past 12 months? Yes No My pet has never had labwork Reason for appointment/main concerns (required) Duration of above concerns/conditions Goals of appointment/treatment? (required) Please list any history of chronic medical conditions. Please list any previous surgery or dental procedures along with approx age or year of last procedure My pet eats the following diet Commercial diet Raw diet Homecooked diet Hay OtherIf your pet on Heartworm prevention? Yes No Not applicable What is heartworm?Is your pet on flea/tick prevention? Yes NoPlease list all medications your pet is currently taking Please list any herbs, supplements, CBD/Hemp etc that your pet is currently taking Does your pet have a history of valley fever? Yes No Never been tested Currently being treated What is valley fever?My Pets behavior at vet clinics (required) My pet needs to be muzzled at the vet office in order to be examined or treated My pet is always muzzed at the vet office as a precaution My pet may need to be muzzled My pet does best in the exam room with me My pet does best when taken out of the exam room away from me My pet takes oral medication prior to vet visits Oral medication taken prior to vet visits has been recommeded for my pet My pet has no temperament concerns that I am aware ofDoes your pet have a history of anxiety? (required) My pet is taking behavior modification prescription medication My pet is working with a board certified behavorialist My pet is working with a trainer My pet has firework anxiety My pet has storm phobia I think my pet may have anxiety My pet has anxiety that is not the same as Fear Aggression or Fear Biting My pet has separation anxiety My pet does not have a history of anxiety to the best of my knowledgeCurrent/Previous Veterinary Practice Phone number or City and State of previous vet. Special requests or conditions? How did you hear about our services? Referral Ad Newspaper Facebook Instagram Other Internet search Nextdoor Google Event Rescue Cozy Couch Directory Local Vet Clinic My pets veterinarian
If referred by an individual, who may we thank for the referral? Additional Pet Information
Pet #2 Name Type of Pet Canine Feline Equine Additional Pet Information
Pet #3 Name Type of Pet Canine FelineNATURE OF SERVICE
Dr. Brown sees patients by scheduled appointment only during regular business hours based on location and availability. Please note this is not an emergency, on-call or overall concierge service. Due to the nature of this service and territory covered, it is recommended that all pet owners be familiar with local vets and emergency clinics in their area should the need arise. Concierge service options available via paid membership packages on a case by case basis pending availability. Soul Puppy is a TCVM specialty office and is not a full service clinic. DEPOSITS/PAYMENTS/CANCELLATION POLICIES
A minimum deposit of $50 per pet is required to confirm all appointments which will be deducted from the invoice total (for approved requests only notified via email). Payment is due at time of services rendered via cash, credit card, zelle or venmo. There is a $25 48 h notice cancellation fee, $50 24 hour notice cancellation fee, $100 same day cancellation fee if less than 12 hours notice (prepaid acupuncture packages automatically forfeit a treatment visit) and a $200 minimum no show/not home fee including forfeit of any prepaid urgent care/emergency/extended travel fees & deposits (prepaid acupuncture packages automatically forfeit a treatment visit). AGGRESSIVE PET POLICY
For safety purposes Dr. Brown has a no aggressive pet policy. She reserves the right to decline a physical exam if a pet displays aggressive behavior, such as growling, snarling, lunging or attempting to bite. If the pet is deemed to be aggressive by the veterinarian, the client agrees to pay in full, the house call and travel fee and a veterinarian consultation fee. Dr. Brown does not accept pets with a history of aggression or in need of sedation for exams. Dr. Brown reserves the right to refuse service at her discretion. CLIENT POLICY
Dr. Brown and staff are happy to assist you and your pet in a mutually enjoyable and respectful working relationship with healthy boundaries as outlined on this website. Dr. Brown is a proud supporter of NOTONEMOREVET and reserves the right to refuse service at her discretion. DIRECT CORRESPONDENCE WITH DR. BROWN
Direct correspondence with Dr. Brown is available via In Person Appointments, TeLeVET Time Remote Support Services & Concierge Package Services. TeLeVET fees apply after initial complimentary follow up per In Person Appointment. Please note unlimited direct correspondence with Dr. Brown via email/phone/text is not included once an appointment has ended. Please request TeLeVET Time for continued support. Online forms & email is the preferred method of communication due to the nature of this practice. Active clients will receive a private number for complimentary text scheduling. This number is for scheduling purposes only (no medical texts please). Thank you PRACTICED POLICY AGREEMENT
I have read the Deposit/Payment/Cancellation, Nature of Service, Correspondence with Dr. Brown, Aggressive Pet and Client Policy and agree to the terms. (required) I Agree I DisagreeI understand that I will receive an email from scheduling@brownvetservices.com regarding my appointment request within 1 to 3 business days otherwise this form did not process correctly and we did not receive it. All required fields must be entered. I understand I must contact my current/previous veterinarian directly and have my pet(s) medical records & vaccine history emailed to records@brownvetservices.com for review. Please note requests are waitlisted until records received. IMPORTANT: Submitting this form completes step one (new client form). Please immediately go to step two (medical records). Requests are wait listed until medical records (step two) are received for review. Please respond to our emails for best service. Complete the verification below