New Client Intake Form
This form is for new equine bodywork clients only. If you are an existing client and need to update me on your horse's recent history, you can email me at info@flourishequinebodywork.com.
Horse Owner's Name
First Name
Last Name
Date
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Month
-
Day
Year
Date
Barn Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please share a Venmo or Zelle where I can send payment requests.
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About Your Horse
Horse Name
Breed
Date of Birth
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Month
-
Day
Year
Date
Sex
Please Select
Mare
Gelding
Stallion
When did you purchase this horse?
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Month
-
Day
Year
Date
Current Veterinarian
Any notable short or long-term health issues, injuries, or behavioral concerns? Have they been resolved?
Please describe your horse's housing situation (stall, turnout, etc.).
When was your horse last shod or trimmed?
When were your horse's teeth last checked?
When was your horse last seen by your veterinarian and why?
What discipline(s) is your horse currently trained and are you aware of any previous training in other disciplines?
Other than your veterinarian, is your horse under the care of any other equine professionals such as an acupuncturist, chiropractor, homeopath, or other bodyworker?
What are your short and long-term goals for your horse (training, competing, health, etc.)?
Anything else you'd like to share?
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Disclaimer & Acknowledgement
I understand that equine massage therapy is never a replacement for proper veterinary care. I understand that my practitioner will not diagnose conditions, attempt chiropractic adjustments, nor prescribe medications or supplements for my horse. If my horse is currently being seen by a veterinarian for the recovery from illness or injury, I have cleared this work with him/her to ensure that massage is appropriate for my horse at this time. I, being the authorized agent or owner of this horse, have read and understand the information on this form. By submitting this form, I hereby release, waive, and discharge Jennifer Thompson and Flourish Equine Bodywork, LLC from all claims, demands, actions, and causes of action of any kind or nature.
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