Lameness History

Lameness History Form

Please use this form to fill out information on your horse’s lameness.

Date
MM slash DD slash YYYY
Owner Name
First Last
Email
Horse Name
Horse's Age
Horse's Gender
Horse's Breed
Horse's Color
Duration of Ownership
Horse's Discipline
What is your primary concern?
When did you first notice the problem?
Was there a specific incident that led to the problem?
Is it improving or getting worse?
Is your horse in current work? If so, what type and how much?
Does the horse work out of it?
When is the problem the most obvious?
Has the horse been seen by another vet? If so, what was done?
Have any x-rays, ultrasounds or other diagnostics been performed?
What treatments have been done? Did anything help?
Is the horse on any medications? If so, when was it last given?
Are there any other problems?
Comments
This field is for validation purposes and should be left unchanged.