Equine Behavioral History 2025

1
Todays Date
Date
Month
Day
Year
2
How did you find us or who referred you
3
Name
4
Address
5
Email
example@example.com
6
Phone Number
7
Name
8
Email
example@example.com
9
Phone Number
10
Horse's name
11
Sex
12
Age
13
Color
14
Breed
15
Clinic name
16
Clinic phone number
17
Dr Name
18
Chief complaint? When did the problem begin?
Date
Month
Day
Year
19
When the horse is alone.
Always
Usually
Rarely
Never
20
In the presence of other horses.
Always
Usually
Rarely
Never
21
In the presence of the owner.
Always
Usually
Rarely
Never
22
In the absence of the owner (other people present)
Always
Usually
Rarely
Never
23
In the stall.
Always
Usually
Rarely
Never
24
In the pasture
Always
Usually
Rarely
Never
25
At competitions or group events
Always
Usually
Rarely
Never
26
Under saddle or at work.
Always
Usually
Rarely
Never
27
Prior to feeding
Always
Usually
Rarely
Never
28
During feeding.
Always
Usually
Rarely
Never
29
After feeding.
Always
Usually
Rarely
Never
30
How often does this behavior occur?
Daily
Weekly
Monthly
31
Has there been a change in the frequency, intensity of the appearance of the problem?
Huge
Large
Normal
Small
Ok
Ok
32
What has been done so far to correct the problem?
Huge
Large
Normal
Small
Ok
Ok
33
What has been the horse’s response to the correction?
Huge
Large
Normal
Small
Ok
Ok
34
Has anything changed in this horse’s environment prior to the appearance of the problem (new stall, new barn, new feed, new horses, new saddle, etc.?) (new stall, new barn, new feed, new horses, new saddle, etc.?)
Huge
Large
Normal
Small
Ok
Ok
35
Type of housing (stall, pasture, run-out shed)?
36
Diet: Grain type? Hay type?
37
What supplements is this horse on?
38
Exercise (hrs. Per wk. ridden/hrs per wk. In paddock)?
39
Type of bit used?
40
Second most recent incident
41
Other horses in the environment and relations between horses (friendly, aggressive, neutral)?
Huge
Large
Normal
Small
Ok
Ok
42
Other animals in the environment?
Huge
Large
Normal
Small
Ok
Ok
43
Primary caretaker of this horse.
Huge
Large
Normal
Small
Ok
Ok
44
Primary trainer of this horse?
Huge
Large
Normal
Small
Ok
Ok
45
Do you compete with this horse? What discipline?
Huge
Large
Normal
Small
Ok
Ok
46
Age at weaning?
47
Age when obtained by the present owner?
48
Were there previous owners?
Yes
No
N/A
49
Do related horses have similar problems?
Yes
No
N/A
50
Age at halter breaking?
51
Method of training to saddle or harness, age when training began?
52
Other types of training methods? (driving, jumping, dressage, games, trail riding, cutting)
Huge
Large
Normal
Small
Ok
Ok
53
Shying, how often and at what?
54
Any other phobias?
55
Head shy?
56
Resentful of grooming/handling (brushing, hoof picking clipping, etc.)?
57
Difficult to handle when hoof trimming or shoeing?
58
Difficult to load or trailer?
59
Aggression towards humans or animals (dogs, cows, etc.) including threatens, strikes, bites, kicks, chases?
60
Aggression toward other horses (threatens, strikes, bites, kicks, chases)?
61
Misbehavior under saddleCheck appropriate behavior
Moves while ride mounts
Backs in harness
Bucks
Rears
Wrings tail
Sensitive to saddling, girth tightening
Wants to lead or will only follow other horses
Runs away when approached
Slow to leave and quick to return to barn
Hard to get or keep on right or left lead
62
Barn VicesCheck appropriate behavior
Aggressive in stall (pins ears, threatens)
Cribs
Chews wood
Food aggressive
Kicks Stall
Paws
Paces
63
Sexual behavior: excessive, inadequate, abnormal? Describe:
64
Maternal behavior: excessive, inadequate, abnormal? Describe:
65
Current medical problems?
66
Past medical problems (surgical or medical)?
67
Medication history?
68
Results of diagnostic tests (radiographs, blood work)?
69
How often are the teeth floated? When was the last float?
70
What are your expectations for your appointment with Animal Behavior Consultants
71
Please check the statement that best describes how you are feeling about your dog’s behavior problem:
I am here only out of curiosity - the problem is not serious.
I would like to change the problem, but it is not serious
The problem is serious and I would like to change it, but if it remains unchanged that’s all right.
The problem is very serious and I would like to change it, but if it remains unchanged I will keep my dog.
The problem is very serious and I would like to change it. If it remains unchanged I will consider having my dog euthanized or give him/her up.
Should be Empty: