• Equine PEMF Intake & Consent Form

    Please complete this form before your horse’s PEMF session.

  • 1. OWNER / AUTHORISED AGENT NAME

    Please provide the details of the horse’s owner or person authorised to consent to treatment.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • 2. HORSE DETAILS

    Please provide some information about the horse receiving PEMF
  • Sex*
  • Primary Use*

  • 3. HORSE HANDLING & SAFETY NOTES

    Every horse is an individual. Please tell us anything that will help us provide a calm, safe and positive PEMF experience for your horse.
  • How would you describe your horse's general temperament?*
  • Has your horse ever displayed any of the following behaviours?*
  • Does your horse have any known sensitive or no-touch areas?*
  • Is your horse head-shy or sensitive around the ears, poll or face?*
  • Is your horse nervous or reactive around unfamiliar equipment, sounds or sensations?*
  • Has your horse previously received PEMF or other bodywork?*

  • 4. REASON FOR PEMF & AREAS OF FOCUS

    Please tell us what you would like to support with your horse’s PEMF session.
  • What would you like PEMF to support?*
  • Is your horse currently under veterinary care for the issue you have described?*
  • Use the body map below as a guide when describing areas of concern or focus.
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  • 5. HEALTH & VETERINARY HISTORY

    Please provide relevant health and veterinary information so we can determine whether PEMF is appropriate for your horse. If you are unsure about any question, please provide as much information as you can.
  • Is your horse currently under veterinary care or receiving treatment for any condition?*
  • Has your horse had any recent injury, illness, lameness or unexplained change in health?*
  • Has your horse recently had surgery, joint injections, soft-tissue injections or another veterinary procedure?*
  • Is your horse currently taking any medications?*
  • Has your veterinarian placed any restrictions on exercise, bodywork, rehabilitation or complementary therapies?*
  • Format: (000) 000-0000.

  • 6. MAGNAWAVE PEMF SAFETY SCREENING

    Please answer every question before your horse receives PEMF. Selecting YES or UNSURE does not necessarily mean your horse cannot receive PEMF; however, treatment may need to be postponed or veterinary advice/clearance obtained before proceeding.
  • Is your horse currently experiencing active bleeding, haemorrhage or a fresh wound that is still bleeding?*
  • Is your horse pregnant or possibly pregnant?*
  • Does your horse have a battery-operated or electronic implanted medical device? Standard passive identification microchips are not included.*
  • Does your horse have cancer, a known or suspected tumour, or is your horse currently undergoing cancer treatment?*
  • Does your horse have a known or suspected blood clot or thrombotic condition?*
  • Is your horse currently taking medication that requires precise dosing, timing or blood-level monitoring?*
  • Does your horse currently have a fever, active infection or systemic illness?*
  • Does your horse currently have an acute injury with significant inflammation, heat, swelling or joint effusion?*
  • Does your horse have a suspected fracture or an injury that has not yet been assessed by a veterinarian?*

  • “IMPORTANT: If you have answered YES or UNSURE to any of the questions above, Honovi Harmonised Health may contact you for further information and may require veterinary clearance before PEMF is provided. PEMF is a complementary modality and does not replace veterinary examination, diagnosis or treatment.”

  • SAFETY REVIEW REQUIRED

    You have identified a condition or circumstance that may affect whether PEMF is appropriate for your horse.

    Honovi Harmonised Health will review this information before treatment. Veterinary advice or clearance may be required before proceeding.

    PEMF will not be provided where a contraindication is identified or where treatment would be outside appropriate safety guidance.

  • 7. VETERINARY CLEARANCE & OWNER CONSENT

    Please read each statement carefully before submitting this form.
  • Has veterinary clearance for PEMF been requested for this horse?*
  • May Honovi Harmonised Health contact your veterinarian if clarification regarding PEMF suitability is required?*
  • Owner / Authorised Agent Declaration*
  • Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Should be Empty: