Bodywork Intake Form

Bodywork Intake Form

Please fill out the short questionnaire so we can tailor your session to suit your horses needs. ***By filling out this form you are consenting to general communications regarding news, scheduling, reminders and follow ups etc…
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Service Booking For:*

Integrative BodyworkPre/Post Event MassageLymphatic Massage
Barn Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gate Code / Special Instructions

Horse Details
Horse's Name, Age, Breed:*
Length of Ownership?*
Current Veternarian(s)*
Prior Injuries and/or Limitations?*
Any Notable Health Issues (Acute or Chronic)?*
Any Behavioral Struggles, Unusual Habits or Struggles (Prior or Current)?*
Current Feeding Program and Housing Habits? *
Please Include all current medications and supplements, whether your horse is stalled or turned out and for how long.
What is Your Horses Current Work Load?*
Please include how many days a week they receive training, work level, how many riders they have etc...
Has Your Horse Ever Been Diagnosed With Gastric or Hind Gut Ulcers?*
Date of Last Dental Exam?*
Date of Last Saddle Fitting?*
Anything Else I Should Know Prior to our Appointment?
Policies & Consent Form

Please carefully review all policy information and sign and initial on the indicated lines.
GENERAL POLICY

In R & R Equine commitment to provide an outstanding and professional experience to all of our clients and out of consideration for our time, we have adopted the following policies:
- Equines should be caught and groomed prior to SCHEDULED start time. Horses will be dry, free of urine and fecal matter and mud. If horse is not ready at scheduled starting time, the session will be shortened.
- Please have your horse secured in a location of the barn that is quiet and comfortable. For a more relaxed experience for your horse, avoid areas of high traffic and commotion (ie. main barn aisle during feed time).
- It is at my discretion to reschedule in extreme weather CONDITIONS for both safety of client and professional.
- All clients must fill out the appropriate "Intake Form”, as well as "Policy & Consent form" prior to the first session.
- An evaluation is required at the first session for all new equine bodywork clients.
- Payment is due at the time of service by one of the following methods: Cash, Check Venmo, Zelle, or Paypal. There will be an additional fee per day for any payments not made at time service is rendered. Returned checks will incur an additional $50 charge.
- During the appointment, R & R Equine may suggest additional services not included in the original estimated price. The owner reserves the right to decline additional services that may change the final price, but understands in doing so they forfeit potential benefits from those services.
- It is at my discretion to end a service early if your equine is displaying dangerous behavior that could harm mine or their own safety; the full amount of payment will be expected.
I hereby read and acknowledge the requirements. I understand that failure to adhere to these policies may result in additional fees.
Signature*

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CANCELLATION / LATE POLICY
- Cancellation within 24 hours of scheduled appointment time will result in a $50 fee.
- Appointments forfeited without notice or communication ( no call no show ) will result in a fee equal to the full amount of scheduled services.
- Repeated cancellations can risk the chance of no longer receiving services in the future and will require the full amount of payment at the time of scheduling future sessions.
- Arrival past scheduled start time will result in a loss of time from your equines scheduled session.
- Arrival greater than 15 minutes past scheduled start time without notice are at my discretion to reschedule and will result in a fee equal the total price of scheduled services.
We ask that you kindly respect our time and give us at least a 24 hour notice of cancellation. However, we also understand horses can be unpredictable, so we strongly encourage communications as early as possible to come to swift resolution.

I hereby read and acknowledge the requirements. I understand that failure to adhere to these policies may result in additional fees.
Signature*

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EXISTING MEDICAL CONDITIONS / VETERINARY DISCLAIMER

It is the responsibility of the client to keep R & R Equine informed of any medical treatment, current medications, or changes in the animal’s health condition. If necessary, the client may be asked to obtain written permission from the veterinarian, or other health professionals that our services are safe to continue.

Bodywork should not be scheduled within 3 days of routine vaccinations. Please check with your veternarian regarding all other injections and proper wait time protocals.

Bodywork is not, nor intended to be, a substitute for veterinary medicine. It is a complementary form of health care. The owner is advised to consult a veterinarian prior to the animal receiving services with any medical concerns or questions and/or to verify with the veterinarian that services is appropriate for the specific animal in question.

R & R Equine is NOT a veterinarian and cannot diagnose nor treat any illness or diseases.

I hereby acknowledge and agree with the requirements.
Signature*

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LIABILITY DISCLAIMER

Working with any animal involves inherent risk. The owner shall agree to not hold R & R Equine, any of her students or employees responsible for any injury or condition that may occur to their animal.

I hereby acknowledge and agree, on behalf of myself and on behalf of my spouse and heirs, to indemnify and save and hold harmless Releasees, and each of them, from any loss, liability, damage, or cost that they, or any of the agent or contractor of Releasees resulting from my participation in personal or online instruction and training.

I further release and discharge, on behalf of myself and on behalf of my spouse, Releasees from all liability to Releasors for injury, death or damage resulting from my participation in personal or online instruction and training as a result of the negligence, or deliberate act, of any other party or parties in attendance.

I expressly acknowledge and agree that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the land, region, state or country, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Further, I fully understand that by signing this document I agree to release all claims, demands and causes of action, including court costs and attorney’s fees, directly arising from any action or other proceeding brought by, or prosecuted for, my benefit contrary to this release, extended to all claims of every kind and nature whatsoever whether known or unknown.

R & R Equine reserves the right to stop an appointment at any time if they feel their or the horse’s safety is in question &/or if the horse is not responding appropriately to the treatment.
Signature*

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I First Name* Last Name*
give the equine body worker, Joely Higgins, permission to perform integrative bodywork, saddle fitting and other adjacent modalities on this horse. I understand massage and other modalities that may be used are never a replacement for proper veterinary care. Signature* If this horse is undergoing treatment for a medical condition, I have cleared this work with the attending veterinarian to ensure bodywork is appropriate to the horse at this time. I affirm that I have provided all relevant information and will update Joely when new information is acquired. Signature* I First Name* Last Name* will practice safe biosecurity and notify R & R Equine of any symptoms and or sick horses on the property, if we had an appointment scheduled or she has visited the farm in the last 14 days. Signature*

I HAVE READ THE ABOVE AND AGREE TO ALL POLICIES AND RELEASE R & R EQUINE AND HER STUDENTS, EMPLOYEES OR HELPERS FROM ALL LIABILITIES.
Signature*

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Bodywork Intake Form

Horse Details

Policies & Consent Form