New Equine Client Health History Intake

New Client Health History Intake
This form serves as a valuable resource for me to gain insight into your horse's current and past health history, training and exercise regimen, and behavior. This essential information enables me to better comprehend your horse's current condition and specific needs. By combining this knowledge with my physical assessments during the massage, I can develop a strategic and tailored massage therapy plan that addresses your horse's unique requirements.
1. Please complete this form to the best of your ability. Note that some questions may not be applicable (write N/A) and others may require further in-person discussion.
2. Read and sign the agreements
3. Submit
Guardian Information
First Name*
Last Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about Schuyler-Moon Equine Massage?
Who referred you?
I'd love to thank them for their support!
Other
Please provide the address where your horse is currently living / where the service will take place.
Stable Name
If applicable.
Horse Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Emergency Contact First Name
Alternative contact (barn staff, trainer or a friend/family member) that knows your horse.
Emergency Contact Phone Number
Please enter a valid phone number.
Horse Bio
Horse Name*
Age*
Breed*
Gender*
Color
Height
Health History
Veterinarian Name
Veterinary Clinic*
Current medical conditions, medications, and supplements*
Past medical conditions and surgeries*
Include dates and relevant details.
Current or previous bodywork experiences?
Massage, Chiropractic, Acupuncture, Physical Therapy, etc.
Anything else related to your horse's body and health I should know?
Examples: Any observed or known muscle soreness, tension, weakness, or limitations of movement. Places they don't like to be touched. Recent breeding or near future plans to breed. Recent dental or farrier observations.
Training
Actively trainingPreparing for showsCurrently showingCurrently in a lesson program (single rider)Currently in a lesson program (multiple riders)Coming back into work post-breakComing back into work post-rehabTemporarily off work for a breakTemporarily off work for rehabRiding for pleasureRetired (light riding)Retired (no riding)Other
Primary Discipline*
Current Level*
OR level before retirement
Training Schedule / Frequency*
How often does your horse train, clinic, or show? Are there rides with a trainer?
Current Training Goals and Challenges*
What are you working toward with your horse today?
Turnout Schedule and Additional Exercise Information*
What does your horse do when you are not riding them? What other disciplines do they do besides their primary?
Other Relevant Training Information
Anything else you can think of related to exercise, training, showing, etc.
Behavior
Temperament and General Behavior*
Known Behavioral Issues / Patterns
Biting, pawing, cribbing, weaving, stall kicking, aggression toward certain people or horses, etc.
Other Relevant Behavior Information
Likes, dislikes, preferences, fears, sensitivities, etc.
Policies and Agreements

Please carefully review and select each policy and agreement to indicate your understanding. Sign the form to confirm your agreement with all policies.
Client Representations and Authorizations
I hereby grant Anne Schuyler-Moon, the equine bodyworker, permission to perform bodywork on this horse, including but not limited to massage, myofascial release, stretching, acupressure, trigger point therapy, craniosacral therapy, use of kinesiology tape, balance pads, and bodywork tools. I understand that while bodywork is beneficial, it does not replace proper veterinary care. The equine bodyworker will not diagnose conditions, perform adjustments or musculoskeletal manipulations, or prescribe medications, nutraceuticals, or supplements for my horse. If my horse is currently undergoing treatment for a medical condition, I have obtained clearance from the attending veterinarian to ensure that bodywork is appropriate at this time. I confirm that I have provided all relevant information and will promptly update the equine bodyworker with any new information acquired.*

I am in full agreement to the stated client representations and authorizations clause.
Photos and Social Media Release
I fully understand a photo will be taken of my horse for an internal directory and assessment photos and videos will be taken for internal use only.
I hereby grant Schuyler-Moon Equine Massage and Anne Schuyler-Moon permission to capture photos or record videos of my horse, and to use and display my horse's image and likeness on Schuyler-Moon Equine Massage's and/or Anne Schuyler-Moon's Instagram, TikTok, Facebook, and other pertinent social media platforms; website, blogs; and educational materials.I do not grant permission to publicly share my horse's image.
Cancellation Policy
I am in full agreement to the stated cancellation policy.
Unforeseen events can occur in everyone's life, cancellation fees may be waived at my discretion.
No-Show Policy
I am in full agreement to the stated no-show policy.
By signing this document, I hereby confirm that I have completed this form to the best of my ability and willingly agree to abide by all stated authorizations and policies.
Signature*

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New Client Health History Intake

Guardian Information

Horse Bio

Health History

Training

Behavior

Policies and Agreements

Client Representations and Authorizations

Photos and Social Media Release

Cancellation Policy

No-Show Policy