Revive Intake + Liability

Preparing for your session

Intake Form + Liability Waiver
OWNER INFORMATION

Please complete an intake form for each individual horse being seen.
Owner's Name*

First NameLast Name
Phone Number*
Email *
example@example.com
How did you find out about Revive Integrated Equine Bodywork?

HORSE'S INFORMATION

Please complete an intake form for each individual horse being seen.
Horse's Name*
Breed*
Gender*
Age*
Color*
Height*
Name of facility or barn session will be occurring at? If private please indicate that.*
Address in which the session will be held*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

HORSE'S HISTORY

Please complete an intake form for each individual horse being seen .
What would you consider this horse's primary job to be?*
How long have you owned this horse?*
When were this horse's teeth last addressed?*
When were this horse's feet last addressed?*
Have you ever dealt with saddle fitting concerns? *
What are your goals for this horse? Is this bodywork session intended as part of your horse's well-being protocol, or are there specific areas of concern you'd like for me to address*
Please describe any past injuries, lameness or illnesses this horse has experienced. *
Are there any personality traits or vices I should be aware (cribber, nippy, anxious when alone, sensitivities, strong behavioral reactions…etc)?*
Is there any other information you'd like to share that you feel would be beneficial for me to know about your horse?
I have reviewed the "Session Preparation" page at https://www.reviveequinebodywork.com/preparing-for-your-session*

Yes, I have reviewed and acknowledge what is recommended to best prepare myself, my horse and my environment for the scheduled bodywork session.

Preparing for your session