• HORSE INTAKE FORM

  • Hair Analysis

    Thank you for trusting me with your horse's wellness. This form helps me gain a complete and intentional understanding of your horse and your goals. Please submit 25 strands of either mane or tail hair in a Ziploc bag labelled with your horse's name and age.
  • Format: (000) 000-0000.

  • HORSE INFORMATION

  • Horse's Date of Birth
     - -
  • Sex

  • Why do you want a scan?

  • What is the main reason you are submitting your horse’s hair sample? Check all that apply.

  • FEED & NUTRITION

  • HEALTH HISTORY

  • Hair Sample Checklist

  • Please Mail To:

    Box 4453

    Ponoka, AB T4J 1S1

    or

    Courier or Drop off To:

    Ponoka Health & Wellness

    5101 49 Ave

    Ponoka, AB  T4J 1H9

     

    Investment Fee:  $190.00

    e-transfer 4kmasters@gmail.com

  • Consent & Disclaimer

    Hair analysis is a wellness screening tool intended to provide insight into possible stressors, imbalances, and areas of support. It is not intended to diagnose, treat, cure disease and is not to substitute veterinary care.
  • I have read and understand the disclaimer above and agree to proceed.
  • Today's Date
     - -
  • Should be Empty: