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Questionnaire

Your Name:
Street Address:
Town:
State: Zip Code:
Phone:
Cell:
E-Mail:

The following information will assist me in preparing a more effective session for your horse.
Horse's Name:
Age: Breed: Gender: Stallion
Gelding
Mare

Please give a brief history of your horse from foal to the present including current use, training, nutrition, health, illnesses, injuries, etc.

Major concerns or issues:

Diet (including types of hay, grains, and supplements):

Please check all that apply:
Ligament/Tendon Issues Hoof Issues Muscle Stiffness Edema Neck Stiffness Chronic Eye Issues
Back Issues Allergies Stifle Issues Arthritis Colic/Digestive Problems Skin Disorder

Stabling:
Stall Pasture

Paddock Turnout (Hours per day: )