Intake Form

Our Intake Form provides us with information, so we can customize our services to each and every horses needs.

Name of Owner *

First

Last

Phone Number *

Email Address *

Barn Address *

Where is the Horse Located *

Horses Name *

Date of Birth *

Weight *

Height *

When did you purchase this horse? *

Current Veterinarian/Hospital *

What is the Purpose of this Session? *

Regular Maintenance
Special Occasion
Lameness or Injury

Any noticeable long or short-term health issues, injuries or behavioral concerns. Have they been resolved? *

Describe your horses housing. (Stall, turnout, etc.) *

When was your horse last shod or trimmed? *

When were your horses teeth last addressed? *

When was your saddle and tack last checked? *

When was the last time your horse was seen by a vet and why? *

What discipline(s) is your horse currently trained and are you aware of any other previous training in any other discipline? *

Other than your vet, is your horse under the care of any other equine healthcare professional(s)? *

What are your goals for your horse (e.g. training, competing, health, etc)? *

Anything else? Please add any other comments!

By checking this box, I agree to the disclaimer notice.

Disclaimer: I understand that equine massage 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 work with him/her to ensure that massage is at this time appropriate for my horse.

was last your

By typing your first and last name and today's date below, you are agreeing to the following statement: *

I, being the authorized agent or owner of this horse, have read and understand the information on this form. I understand that bodywork is not a substitute for veterinary care, and that it is my responsibility to consult with a veterinarian regarding complementary care for my horse. I hereby release, waive and forever discharge the above named equine sports massage therapist from all claims, demands, actions and causes of any actions of any kind or nature.