Horse Information Form in Laporte, CO

Name
Breed
Birthdate or age
Gender
Branded? Tattooed? If so, brand/tattoo location/ number/letters
Markings
Date of last vaccinations:
Rabies
Eastern/western Encephalitis
Tetanus
Rhino
West Nile
Strangles (intranasal or injectable?)
Other vaccines-type?
Date of last coggin's testing
Date of last veterinary examination and Name of veterinarian, if known?
Date of last dental examination/float?
Do you have any concerns with your horse's health today?
Diet
Hay-what type and how much per day?
Grain-type and amount?
Formulated feeds? Type and how much/trow many times per day?
Any supplements (including herbal) or long term medications?
Lifestyle
What activity do you primarily use your horse for?
Do you show your horse or engage in other activities where there are multiple horses together?
How many days a week do you ride?
How many hours at a session/average?
Any issues with bitting problems, dropprng grain or head tossing?
Any concerns with lameness? If so which leg and for how long?
Has your horse lived in any other state or country? If so where and when?
Do you frequently trailer your horse?
Does your horse have any special shoeing needs or chronic foo/leg problems?
Any other chronic health conditions (including respiratory conditions?)

Horse Information Form