VCPR-Veterinarian Client Patient Relationship |
My pet is an ACTIVE patient with Dr. Brown via (required)
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My pets most recent exam or acupuncture treatment with Dr. Brown (required)
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Pet Care Team |
Has your pet been seen by another DVM, ER, Urgent Care, Specialist, Chiropractor, etc. since your most recent appointment with Dr. Brown? (required)
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If yes answered above, please provide additional information (reason for appointment & treatment provided)
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Progress Form Details |
Purpose of form submission (required)
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Email address (required)
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Pet Patient Info |
Pet Name (required)
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Species
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Medication |
Medications with Doses currently being given (for best service please do not write same as previous) (required)
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Chinese Herbal Prescription |
Chinese Herbals with Doses currently being given (for best service please do not write same as previous) (required)
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Supplements |
My pet takes the following supplements (required)
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Additional space for supplement details (please write numbers from above if more than one & provide details if others not listed)
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Diet |
Current Diet (for best service please do not write same as previous)
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Appetite & Gastrointestinal Concerns |
Appetite (required)
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Vomiting (required)
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Stools (required)
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Additional space for Appetite or Gastrointestinal Concerns
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Cardiovascular & Respiratory Systems |
Heart & Lungs (required)
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Skin & Ears |
Allergies (required)
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Level of Itchiness (required)
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Ears (required)
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Additional space for Allergy & Otitis (ear) concerns
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Neurology |
Nervous System (required)
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Additional space for nervous system concerns
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Musculoskeletal System |
Musculoskeletal (required)
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Additional speca for musculoskeletal concerns
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Update & Progress Information (please be as specific as possible to avoid back & forth communication)
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Questions or concerns for Dr. Brown relating to your pets most recent appointment (Please submit a TeLeVET Time form for new concerns or requests)
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Additional Space
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Scheduling |
I would like to schedule an in-person appointment for my pet (required)
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Traditional Chinese Veterinary Medicine (TCVM) |
My pet is a TCVM Acupuncture patient. I would like to request Chinese Herbal Medicine Evaluation with Prescription (prepaid service-first bottle included). (required)
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My pet is a TCVM Acupuncture patient. I would like to request Chinese Herbal Medicine RE-evaluation with prescription (prepaid service-first bollte included) (required)
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My pet is a TCVM Acupuncture patient. I would like to request TCVM Food Therapy-BASIC: food energetics chart, basic food therapy info & sample recipe (prepaid service) (required)
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My pet is a TCVM Acupuncture patient. I would like to request TCVM Food Therapy-CUSTOM: additional custom recipes after basic above (prepaid service) (required)
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Complimentary Follow Up: I understand I will receive a complimentary email follow up from Dr. Brown within 7 business days if it has been two weeks or less since my pets in person appointment
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Status Updates only: I understand this is an update and progress form only and does not include a response from Dr. Brown. However Dr. B. may suggest an in person appointment or TeLeVET Time based on information provided. Thank you
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Active Patient Progress Form