Veterinary Consent Form
This form is to be completed by the attending veterinary surgeon prior to any horse undergoing hydrotherapy or related therapeutic services at Yorkshire Equestrian Centre / The Hydrotherapy Hut where a clinical or rehabilitative need is present. For horses attending for general fitness, conditioning, or maintenance use without any current or ongoing medical issues, formal veterinary consent is not required. However, we strongly recommend that you inform your vet, physiotherapist, and farrier that your horse is beginning Water Treadmill sessions, especially where there may be underlying asymmetries or management considerations.
Owner's Name
*
First Name
Last Name
Horse Name
*
Horse Age
*
Horse Sex
*
Mare
Gelding
Stallion
Horse Colour
*
Veterinary Practice
*
Attending Veterinary Surgeon
*
Vet's Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Clinical Background: Please summarise the horse’s relevant clinical history or condition.(Include diagnosis, surgery, injury, rehab stage etc.)
*
Current Stage of RecoveryWhat stage of recovery is the horse currently at?
*
Fully recovered and returning to work
Mid-rehab phase – controlled exercise allowed
Early rehab – restricted movement only
Ongoing clinical investigation
Other - please specify
Type a Referral Type & SuitabilityPlease confirm which services you are happy for the horse to receive:(Tick all that apply)
*
Water Treadmill
Dry Treadmill
Postural assessment
Weight Management
Gait observation and conditioning
Livery-based programme
Other - please specify
Do you have any restrictions or specific recommendations?(e.g. limit water height, avoid incline, only dry work)
*
Any further details you wish to add?
*
Declaration:
*
By ticking this box, I confirm that I am the attending veterinary surgeon responsible for the horse named above. I certify that the information provided is accurate, and I consent to the horse receiving treadmill therapy and related rehabilitation services at Yorkshire Equestrian Centre / The Hydrotherapy Hut as outlined in this form.
Name
First Name
Last Name
MRCVS Number
*
Date
*
-
Day
-
Month
Year
Date
Vet Letter/Stamp (Optional)
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Any documents relevant to the horse's diagnosis, treatment etc we need you can upload here (optional) or email to office@yorkshireec.co.uk
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Submit Consent
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