Healthy Horse Registration

1
Owner's Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Area Code
Phone Number
4
State* This field is required.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
5
Horse's Name* This field is required.
6
Horse's Breed* This field is required.
7
Horse's Age* This field is required.
8
Horse's Sex* This field is required.
Mare
Stallion
Gelding
9
Has your horse had laminitis (founder)?
YESNO
10
Select all applicable events that happened immediately prior to the laminitis (founder) episode:
Got Into Grain
Farrier Shoeing
Joint Injections
Medication Treatment
Spring Grass Turnout
Change in Feeding Protocol
11
Does your horse have decreased energy (lethargy)?
YESNO
12
Has your horse experienced a change in attitude?
YESNO
13
Does your horse have decreased athletic performance?
YESNO
14
Does your horse have difficulty shedding his winter coat?
YESNO
15
Does your horse have excessive patchy hair growth?
YESNO
16
Does your horse have irregular sweating (increased/decreased)?
YESNO
17
Has your horse experienced weight loss?
YESNO
18
Has your horse experienced rapid/unusual weight gain?
YESNO
19
Does your horse have fatty deposits on his neck, shoulder, belly, or rump?
YESNO
20
Does your horse have a rounded abdomen?
YESNO
21
Has your horse experienced muscle atrophy?
YESNO
22
Has your horse experienced a loss of topline muscle?
YESNO
23
Does your horse have tendon laxity?
YESNO
24
Are your horse's feet sore after being trimmed?
YESNO
25
Is your horse prone to recurrent infection (sole abscesses, etc)?
YESNO
26
Does your horse drink excessively?
YESNO
27
Does your horse urinate excessively?
YESNO
28
Has your horse experienced eye problems?
YESNO
29
Did You Know...... 21% of Horses Over 15 Years of Age Suffer from PPID?
YESNO
30
Did You Know....... 15% of PPID Horses Are Under the Age of 15?
YESNO
31
Did You Know....... That All Horses Are At Risk For EMS?
YESNO
Should be Empty: