Equine Intake Form

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

  • In Hands
  • Aquisition

  • Lifestyle and Management

  • How many hours a day? On grass field or dirt paddock?
  • Please list vaccinations and include frequency of shots. Also, please explain if and how the routine and frequency has changed over the years.
  • For reference only. I will not contact the individual unless you ask me to do so.
  • Medical History

    Include anything historic and significant that has occurred while you have cared for this horse and prior to your aquisition, if known.
  • Colic episodes, surgeries, illness, malnutrition, etc.
  • Abscess, tendon strain, arthritis, fall, flip, head injury, etc.
  • Current Condition

    Any health issues this horse has presently.
  • For reference only. I will not contact your veterinarian unless you specifically ask me to.
  • Please list any medications your horse is currently taking: dosage; start and end dates of meds; and why. Include Phenylbutazone (Bute.)
  • Where on its body is it not comfortable being touched and what is his or her reaction?
  • Your Relationship With Your Horse

    This section is optional.
  • Healing Session Focus

    Please take the neccessary time to consider the following questions.
  • Examples: Deepening the bond between us, more mutual understanding or clearer communication.