Client Intake Form - Major's Horse Massage

Client Equine Intake Form

Date:*
Date Format: MM slash DD slash YYYY

Date of form completion
Name:*
First Last
Email:*
Enter Email Confirm Email
Phone:
Vet's Name:
Reason for interest in bodywork:
HORSE INFO: Name:*
Age of Horse:*
Breed:*
Gender*
Barn Address:
Notable Long - or - Short term health issues, injuries, or behavioral concerns. Have they been resolved?
Current feeding regimen:
Describe your horse's housing (stall, turnout):
Date teeth last floated:
Date Format: MM slash DD slash YYYY
Name of farrier and where in cycle:
Date of last vaccines:
Date Format: MM slash DD slash YYYY
Were there any reactions?
Horse's discipline:
Use of horse and number of days per week:
Number of riders:
Are there multiple types of tack used? Check all that apply.
- Saddle
- Bridles
- Bits
- Use only one of each
Is there anything else you feel is relevant to share about this horse?
Who referred you to Major's Horse Massage?