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Program Horse Questionnaire
Program Horse Questionnaire
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Lease
Donation
Purchase
Undecided
Date:
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Owner's Name:
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Phone: Home:
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Phone: Home:
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Cell:
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Email:
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Street Address:
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City:
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State:
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Zip:
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Location of Horse:
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Horse's Name:
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Age:
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Horse's Birthday:
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Gender:
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Height:
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Approx. Weight:
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Breed:
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Markings:
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Length of Ownership:
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Color:
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How did you hear about us:
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Personality
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Dominant
Aggressive
Passive
Other
Other
Temperament:
(1= very calm, 10= very High Spirited)
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Habits:
(Weaving, cribbing, biting, kicking, etc.)
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Current Veterinarian:
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Phone:
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Medical Conditions:
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Physical Limitations:
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History:
Colic
Founder
Other:
Is your horse easily ridden in all three gaits (walk, trot, and canter)?
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If not, please explain:
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Permission to receive records:
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Yes
No
Vaccinations:
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West Nile
Flu/Rhino
Tetanus
Strangles
E&W Encephalomyelitis
Rabies
Other
Other
Date of Last Vaccinations:
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Annual
Semi-Annual
Equine Dentist:
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Phone:
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Date of last Float:
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Current Farrier:
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Phone:
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Shoeing Needs:
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Manners:
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Stabling:
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Stall
Pasture
Paddock
Other
Other
Feed:
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Grass
Alfalfa
Supplements:
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Other:
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Trailering:
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Slant Load
Straight
Stock
Does your horse back out of the trailer?
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Attitude in the Trailer:
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Ground Manners:
Grooming:
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Tacking:
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Clipping:
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Other:
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Ties:
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Ground Ties
Cross Ties
Post Ties
Other
Other
Tack & Experience/Training
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English
Western
Bareback
Neck Rein
2 Reins
Leading
Lunging
Long Lining
Arena
Trail
Shows
Voice Commands
Other
Other
Comments on Tack & Experience/Training:
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How is your horse around children and beginners?
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Have beginners/children ridden:
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On lead
Independent
Explain:
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Other pertinent information:
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