EQUINE HEALTH & BACKGROUND INFORMATION

EQUINE HEALTH & BACKGROUND INFORMATION
ASSESSMENT DATE *

Month Day Year
Date
HORSES NAME *

Barn Name Show Name
BREED *
AGE *
DESCRIPTION *
(Ex. Dark Bay with blaze and 3 white socks)
DISCIPLINE *

Hunter Jumper Dressage Eventing Roping Barrel Racing Other
STABLES *
VETERINARIAN *
FARRIER *
BODYWORKER *
(Ex. Chiropractor)
OTHER
PLEASE CHECK ANY THAT APPLY TO YOUR HORSE *

Joint pain/ swelling/arthritis Disk or vertebrae problems Diarrhea/constipation Eye/Ear problems Hip problems Leg problems Open wounds/sores Skin disorders/infections Heart disease Anxiety Newly healed area Undiagnosed lump History of abuse In seaon Pregnant Nursing Cancer Allergies None of the above
Is the horse aggressive? *

Yes No
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:

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