Earth Horse Healing

Ginger Krantz - Healer, Teacher, Mentor

Horse or Equine Intake Form

Equine Intake

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.

"*" indicates required fields

Name of Owner*
Home Address*
Location of Equine(s)*
Address of Equine Facility
Session Format*
Appointment Scheduling*
Please choose all the times you are available in Eastern Time and can be with your horse. Please pull any feed/hay out of the stall, or small paddock, for the duration of the session. It is important that your horse/equine is either turned out or hand grazed after the session, so he/she can move freely.

Description

In Hands, an approximation is fine.
Sex*
The Age Specified Is:*

Aquisition

Lifestyle and Management

Please provide brand names.
How many hours a day? On grass field or dirt paddock?
Do you utilize fecal testing?*
How frequently do you worm?*
Hoofcare*
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.
Lyme, EPM, colic episodes, abscess, tendon strain, arthritis, fall, flip, head injury, surgeries, malnutrition, 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.)
Is your horse comfortable being touched all over its body?*
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.
Would you like to be added to my email list?*
For announcements about events and classes.