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
Is the horse aggressive?
Yes
No
Does the horse have any vices? If so, please describe:
Is the horse on any medication? If so please describe:
Any surgeries or significant injuries? If so, please describe what and when:
Has your horse ever received professional massage or bodywork? If yes, what kind and why?
What is expected from the treatment your horse is about to recieve?
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