Equine Client Intake Form Your Name (required) Your email address (required) Your Telephone(required) Your Mailing Address (required) Preferred method of Contact? Email Phone Both Horse's Name Breed Sex Stallion Gelding Mare Date of Birth Height Weight Current Veterinarian Name and Contact Info When was the last time your horse saw a vet and why? Please list any short or long term health issues, injuries, performance and/or behavioral issues: How long have you owned the horse? What is the current training program you have your horse in? Are you aware of any previous training programs your horse was trained in before you owned him/her? What are you currently feeding your horse? Is your horse on supplements or medications? Yes No Please describe how your horse is housed? (stall, turnout, etc) How many people ride and/or train your horse? When was the last time your horse was treated by a farrier? (Shod, Trimmed, etc.)? When were your horse's teeth treated and/or assessed and by whom? When was your horse last vaccinated and with what (West Nile, Booster, etc.) Has your saddle/tack ever been assessed? If so, when? (If Female) Is she in foal, has she ever foaled, or has she ever had trouble while in season? Other than your veterinarian, has your horse been in the care of any other healthcare professional such as a chiropractor, acupuncturist, body worker, etc.? If so, when? What are your goals for your horse? (ie competition, training, general health, etc.) Is this session intended as part of your horse's general well being, or do you have specific concerns you would like to address. Please be specific. Did I miss anything? Please feel free to add additional comments or anything I may need to know.