Copper Oak Equine Client Intake

Copper Oak Equine Client Intake
Owner:
Full Name

First NameLast Name
Address
Street
City
Province
Postal Code
Phone Number
Format: (000) 000-0000.
E-mail
Horse:
Name:
Age
Breed:
Sex
Pregnant/Poss. Of Being Pregnant?
How long have you owned the horse?
Horse's Location

Farm Name

Street Address

CityProvince

Postal Code
Veterinarian
Date of Last Visit + Reason For Visit:
Any Current Injuries or Health Conditions:
What Treatments is the Horse Receiving:
Past Injuries, Health Conditions, or Surgeries:
When Did These Occur:
What Treatments Did The Horse Receive:
Did The Treatments Work?
If your horse is currently being treated for injury, has recently had surgery, or has chronic condition, does your vet approve of bodywork for this horse?
Is your horse on any medication?
Farrier:
Last Trim/Shoe:
Date
Frequency of Trimming/Shoeing
Saddle Fitter, Bit/Bridle Fitter:
Date of Last Fitting/Adjustment:
Other Bodyworkers:
Names, type of service
How Often Does Your Horse Get Bodywork?
Date of Last Bodywork Session:
Horse's Life + Activity Profile
Riding/Training Discipline:
Current Workload:
What Are Your Goals With This Horse:
Describe Your Horse's Diet:
Hay, Pasture, Grain, Supplements
Describe Your Horse's Living Arrangements:
Stall and Turnout Duration, Group/Individual, etc.
Does Your Horse Nip or Kick During Grooming or Tacking
Any Behaviour "Quirks" I Should Know About:
What Is The Primary Reason For Contacting Copper Oak Equine For a Session?
What Are Your Expectations Regarding Bodywork:
Are You Willing To Discuss Changes To The Following, If Recommended?
Tack or Blanket Fit
Turnout/Environment
Exercise/Training
Feed/Diet
Trim Cycle
If you were referred, enter the name of person that referred you:
Terms and Conditions
I understand that the Equi-Bow techniques are not a “therapy,” and are not a replacement for licensed veterinary diagnosis and treatment. I have been advised to seek a licensed veterinary practitioner for diagnoses, therapy, and treatment for my horse, for any health concerns I have.
I voluntarily consent to the application of the Equi-Bow technique by Copper Oak Equine.
Owner Name:
Date:
Signature
Payment is due upon services rendered. Cash only

24 hours notice of cancellation is required.
50% fee applies to cancellations of less than 24 hours.
Should be Empty:

Copper Oak Equine Client Intake

Horse:

Horse's Life + Activity Profile

Are You Willing To Discuss Changes To The Following, If Recommended?

Terms and Conditions