Horse Healing Follow-Up Form | Earth Horse Healing

Only the fields marked with a red asterisk are required. Please fill out and submit this form at least 48 hours prior to your appointment. The information you provide is held as private and will not be shared without your expressed permission.

"*" indicates required fields

Contact Information

Name*

First Last

Primary Phone*

Email*

Previous Session Results

Name of Equine*

Age of Equine*

Please describe any improvements as a result of our last session: physical, emotional, mental and behavioral.

Current Condition:

Previous and new veterinary diagnoses.*

Please describe any new developments in your horse's health condition.*

Please list any medications your horse is taking, include the start and end dates.

Lifestyle and Management

Daily diet and supplements.*

Please include brand names.

Current turn out, exercise and lifestyle.*

Any changes in hoof care or shoeing?*

Healing Session Focus

Please take the neccessary time to consider the following question.

What changes would you like to see in your horse as a result of the healing session?*

Please include changes you would like to see in your relationship with your horse, as well. Thank you.

Contact Information

Previous Session Results

Current Condition:

Lifestyle and Management

Healing Session Focus

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