Rochester's Only Canine and Equine Rehabilitative Care Center
Providing Veterinary Rehab, Sports Medicine, Acupuncture and Chiropractic Services

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He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true, to the last beat of his heart. You owe it to him to be worthy of such devotion.

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TheraVet Acres New Equine Client Information Form

First Name

Middle Initial

Last Name

Address

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

Barn Phone

E-mail

How Did You Hear About Us?

Registered Name

Horse's Stable Name

Breed

Birthdate

Sex

When did you obtain the horse?

Where was your horse obtained from?

Horse's Stable Address

Regular Veterinarian

Discipline

Do you compete?

How exercised

How often exercised

Turnout

Brand/Type of feed

How often fed

Supplements given (with amounts)

Medications (with amounts)

Allergies

Farrier

Date of last shod/trimmed

Shoes (select one) Front All Around Barefoot

When were the teeth last floated/checked? By who?

Any vices? (Towards humans, kicking, biting, etc.)

Describe your horse's typical temperament

Any history of past injury, lameness or illness?

Current issue

Any recent x-rays, blood work, or other diagnostics performed for this condition?

Has the horse previously had a chiropractic adjustment?

How did he/she respond?

Has the horse previously had acupuncture?

How did he/she respond?

Please give us any other information that you feel could be beneficial to us in helping your horse: