EQUINE HEALTH & BACKGROUND INFORMATION

EQUINE HEALTH & BACKGROUND INFORMATION
ASSESSMENT DATE*

MonthDayYear
Date
HORSES NAME*

Barn NameShow Name
BREED*
AGE*
Type a question

MareGeldingStallionFillyColt
DESCRIPTION*
(Ex. Dark Bay with blaze and 3 white socks)
DISCIPLINE*

HunterJumperDressageEventingRopingBarrelRacingOther
STABLES*
VETERINARIAN*
FARRIER*
BODYWORKER *
(Ex. Chiropractor)
OTHER
PLEASE CHECK ANY THAT APPLY TO YOUR HORSE*

Joint pain/ swelling/arthritisDisk or vertebrae problemsDiarrhea/constipationEye/Ear problemsHip problemsLeg problemsOpen wounds/soresSkin disorders/infectionsHeart diseaseAnxietyNewly healed areaUndiagnosed lumpHistory of abuseIn seaonPregnantNursingCancerAllergiesNone of the above
Is the horse aggressive?*

YesNo
Does the horse have any vices? If so, please describe:*
(Type N/A if this does not apply)
Is the horse on any medication? If so please describe:*
(Type N/A if this does not apply)
Any surgeries or significant injuries? If so, please describe what and when:*
(Type N/A if this does not apply)
Has your horse ever received professional massage or bodywork? If yes, what kind and why?*
(Type N/A if this does not apply)
What is expected from the treatment your horse is about to recieve?*
Should be Empty: