Intake Form

Thank you for choosing equine equilibrium for your horse's physiotherapy needs.  THESE FORMS ARE QUITE COMPREHENSIVE AND ALLOWS US TO PROVIDE THE BEST POSSIBLE CARE FOR YOUR BELOVED COMPANION.

HORSE/MULE CLIENTS: pLEASE FILL OUT THE FORM BELOW.  

ALL OTHER CLIENTS: PLEASE SCROLL DOWN AND FILL OUT SECOND FORM FOR SMALL ANIMALS

Date *
Date
Name *
Name
Please describe any previous or ongoing hoof issues, such as thrush, white line disease, laminitis, navicular syndrome, thin soles, frequent abcesses, frequent throwing shoes, how often feet are trimmed/shod
Please check boxes if your horse is sensitive to being: *
Please let me know if your horse has ever foundered, bowed a tendon, any fractures, injured tendons or ligaments, had stifle or hock issues, if you get your horse injected with steroids for any reason, etc.
Name *
Name
Please select. If you choose "other", please add in the species to the Animals Name Example: Thumper-rabbit
If a cross, please describe your best guess.
Inside only/outdoors only, kenneled, etc. Please also include if there are other animals in home.
Please also list if there have been surgeries or major diagnostic work.
Example: Kidney disease, diagnosed 3 yrs ago... or hip dysplasia, confirmed 6 months ago, etc.
Example: eating rocks/trash; small dogs leaping off furniture; instigating rough play with bigger animals
Example: hates tail touched, nervous about men, etc.