Program Horse Questionnaire

Item #1 *
 Lease
 Donation
 Purchase
 Undecided
Date: *
 
Owner's Name: *
 
Phone: Home: *
 
Cell: *
 
Street Address: *
 
City: *
 
State: *
 
Zip: *
 
Location of Horse: *
 
Horse's Name: *
 
Age: *
 
Horse's Birthday: *
 
Gender: *
 
Height: *
 
Approx. Weight: *
 
Breed: *
 
Markings: *
 
Length of Ownership: *
 
Color: *
 
How did you hear about us: *
 
Personality  *
 Dominant
 Aggressive
 Passive
 Other
Temperament: (1= very calm, 10= very High Spirited) *
 
Habits: (Weaving, cribbing, biting, kicking, etc.) *
 
Current Veterinarian: *
 
Phone: *
 
Medical Conditions: *
 
Physical Limitations: *
 
History:
 Colic
 Founder
Other:
 
Is your horse easily ridden in all three gaits (walk, trot, and canter)? *
 
If not, please explain: *
 
 
 
 
 
 
 
Permission to receive records: *
 Yes
 No
Vaccinations: *
 West Nile
 Flu/Rhino
 Tetanus
 Strangles
 E&W Encephalomyelitis
 Rabies
 Other
Date of Last Vaccinations: *
 
Item #36 *
 Annual
 Semi-Annual
Equine Dentist: *
 
Phone: *
 
Date of last Float: *
 
Current Farrier: *
 
Phone: *
 
Shoeing Needs: *
 
Manners: *
 
Stabling: *
 Stall
 Pasture
 Paddock
 Other
Feed: *
 Grass
 Alfalfa
Supplements: *
 
Other: *
 
Trailering: *
 Slant Load
 Straight
 Stock
Does your horse back out of the trailer? *
 
Attitude in the Trailer: *
 
Ground Manners:
Grooming: *
 
Tacking: *
 
Clipping: *
 
Other: *
 
Ties: *
 Ground Ties
 Cross Ties
 Post Ties
 Other
Tack & Experience/Training *
 English
 Western
 Bareback
 Neck Rein
 2 Reins
 Leading
 Lunging
 Long Lining
 Arena
 Trail
 Shows
 Voice Commands
 Other
Comments on Tack & Experience/Training: *
 
 
 
 
 
 
 
How is your horse around children and beginners? *
 
Have beginners/children ridden: *
 On lead
 Independent
Explain: *
 
Other pertinent information: *