Brown Mobile Veterinary Services PLLC

3735 E. Dover
Mesa, AZ 85205

(480)274-3175

brownvetservices.com

Thank you for submitting a new client form.

  • Please have a copy of your pets medical records and vaccine status available and emailed to brownvethc@gmail.com .  Proof of rabies required for all dogs. 
    • It is helpful to leave a phone message stating that a form was submitted, along with your location city/major cross streets/basic description of your pet/appointment needs, etc so we may better serve you, as Dr. Brown is most likely on the road seeing patients.
  • Please see our fees and payment tab for cost information. Payment due at time of services. 
  • Note: Aggressive pet housecalls will not be accepted for safety purposes. Please do not request a housecall if sedation has already been recommended for your pet due to temperment by a brick and mortar clinic. Sedation is not available for housecall patients and aggressive patients will be referred back to a stationary clinic. Owners are responsible for compensating Dr. Brown for time and travel if pets are too aggressive to be safely examined. 
  • EMERGENCIES, please contact the nearest emergency clinic in your area, or call VCA Animal Referral and Emergency Center at 480-898-0001. Note: Brown Veterinary Housecalls is not an emergency, on-call or concierge service. Patients are seen by appointment only subject to availability. Due to the nature of this service it is recommended that all pet owners are familiar with local vets and emergency clinics in their area. 
  • Owner requesting appointment must be present at time of housecall 

Thank you.

New Client

Primary Owner Name (required)
First Name (required)
Last Name (required)
Spouse or Secondary Owner Name
First Name
Last Name
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Major Cross Streets

Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone
Phone TypePhone Number
E-Mail Address (required) :
Pet #1 Name (required)

Age: Years, Months

Type of Pet (Dogs and Cats Only) (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed (required)
Neutered
Spayed
Unknown


Are your pets vaccines current? (required)
Yes
No
Unknown


Do you have your pet(s) medical records? (required)
Yes
No


Please have your pet(s) medical records emailed to brownvethc@gmail.com prior to your appointment
By clicking yes, I agree to have my pet(s) records faxed prior to appointment.
Name of Current/Previous Veterinary Practice

Phone number or City and State of previous vet.

Check the box if you would you like us to call you for your appointment
Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

How did you hear about our services? (required) :
If referred by an individual, who may we thank for the referral?

Pet #2 Name

Type of Pet
Canine
Feline


Pet #3 Name

Type of Pet
Canine
Feline


Pet #4 Name

Type of Pet
Canine
Feline


Pet #5 Name

Type of Pet
Canine
Feline


Aggressive Pet Policy
Safety is important to the staff at Brown Mobile Veterinary Services PLLC. Therefore we reserve the right to decline a physical exam if your pet displays aggressive behavior, such as growling, snarling, 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 fee and a veterinarian consultation fee. By clicking "I Agree" in the section below, you are stating you agree to these terms.
I have read Payment Policy and Aggressive Pet Policy and agree to the terms. (required)
I Agree
I Disagree



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Colleen Brown DVM

Integrative Veterinarian

(480) 494-6034

Brownvethc@gmail.com 

 


East Valley and surrounding areas, Phoenix, Arizona

(Extended service area considered/subject to availability/additional fees apply) 

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