Medical History Form

During the COVID-19 Pandemic, our practice is moving to “curbside care” to limit physical contact and adhere to social distancing recommendations. These new procedures help to limit exposure, not only to pet owners, but also to our veterinary team.

Please call the office to schedule an appointment for your pet.

In order for your veterinary healthcare team to provide comprehensive care for your pet, please fill in this form and return via email prior to your visit.

Date:*
dd/mm/yyyy
Owner's Name
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Pet Information
Pet's Name*
Species*
Breed (if known)
Sex
Color
Date of Birth or Age (if known)
Pet Health - Reason for Visit
Describe your concern*
How long has this been going on?*
Days/Weeks/Months
What are you currently feeding the pet?*
food/treats
How is their appetitie?*
poor/good/excellent
Are you currently giving any medications or supplements?*
- yes
- no
Please specify*
name/dose/last given
Any coughing or sneezing?*
- yes
- no
Please describe*
Any vomiting or diarrhea?*
- yes
- no
Please describe*
Have they gotten into anything? Eaten anything unusual?*
- yes
- no
Please describe*
Is your pet indoors only? (Cats)
Any environmental changes?*
Describe their behavior*
lethargic/normal/hyperactive
Any changes to thirst?*
increased/normal/decreased
Any changes to urination?*
increased/normal/decreased
How are their bowel movements?*
normal/abnormal
When was their last bowel movement*

Expert Mobile Holistic Veterinary Care

Book your pet or horse's appointment today

Contact

Please Text or Email:
517-474-4050
wholelifevet@gmail.com

Dr. Bickel will respond when available. We do not have office staff at this time.

Mobile-Only Practice

Our practice is roughly bordered by Milan to the south, Howell to the North, Stockbridge/Grass Lake to the West and Novi/Canton to the East, including the townships of Ann Arbor, Chelsea, Dexter, Pinckney, Saline, Milan, Brighton, Grass Lake, Manchester, Howell, and Gregory.

If you are outside this area and are interested in services we may be able to arrange it with additional fees based on mileage. Please text or email for information.

Hours by Appointment

In general, appointments are available from late morning to early evening M-F depending on availability. In some instances, after-hours/weekend care is available.

If you have an URGENT need for end-of-life care please text and we let you know if we are available. Emergency charges are applied in some cases.