Questionnaire

Name:

Street  address:

City                     State                     Zip:

Name of Horse:

Age:

Breed:

Sex:

How long have you owned the horse?

Is the horse currently wearing shoes?

What types of shoes?

How long has the horse been shod?

When was your Farrier last out to shoe or trim your horse?

Is the horse lame now?

Has your horse had any vaccinations or been wormed recently?

Has your horse had any changes in diet of living conditions recently?

Is your horse currently on any type of medication?  

                 

What is your Veterinarians name?

Phone number:

Has a Veterinarian seen the horse for lameness issues?

How long ago?

Do you have digital radiographs (x-rays) from your Veterinarian?

Please give a short history of the lameness issue:

Please provide current FULL BODYphotos of the horse taken from the right and left side, back and front:

Please take pictures of all four feet, a side view, front view, and heel view. The pictures should be taken at GROUND LEVEL approximately 3 feet from the horse on all shots.

Pick up all four feet and take pictures of the bottoms of all four feet.

Does your horse have any other health issues? Please explain in detail:

® 2009 Dave Fitton Hoof Care Specialist L.L.C.