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OWNER/CAREGIVER

Please provide the information below as completely as possible. All information is strictly confidential.

HORSE INFORMATION

VET/STABLE INFORMATION

DAILY CARE

***It is important that if your horse has not had routine chiropractic previously, that no major changes to their feet and/or teeth has been done within 10 days of their first chiropractic evaluation. We also do not recommend competing with your horse within 5 to 7 days after their first adjustments as there is a slight possibility of them being sore from an initial treatment.

HISTORY/TEMPERAMENT

ADDITIONAL INFORMATION

STATEMENT OF OWNERSHIP

By checking below you certify that you are the owner and or agent of the above animal and have the authorization to consent to treatment if and when it is needed.

Is there someone whom you give permission to make decisions on treatments and modalities performed (ie trainer)?