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State
Zip
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Phone
Fax
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Horse/Pony Name |
Breed
Age
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Sex |
Approx Weight
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Reason for contact |
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When did you first notice these signs/symptoms? |
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Feeding Program |
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List all Medications, herbs, or supplements being used
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Recent Vaccinations |
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My horse/pony is |
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Chronically Sore hooves? |
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When and how often? |
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Examples of movement activity
at present state
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Examples of movement activity prior to ailment in question |
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Has your horse ever had a laminitic episode? |
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Approximate Date of first laminitic episode |
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Treatment Program for the first episode |
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Date for
Most
Recent Laminitic Episode |
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Treatment Program used for the most recent episode |
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Does your horse/pony now or in the past have/had: |
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Edema/Fluid swelling in the chest, belly legs, shoulders? |
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If yes, when, where and how often? |
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Distended Belly? |
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If yes, when, where and how often? |
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Loose or liquid stool? |
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If yes, when, where and how often? |
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Runny Eyes? |
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If yes, when and what texture and/or color? |
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Runny Nose? |
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If yes, when and what texture and/or color? |
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Loss of Appetite? |
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If yes, when? |
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Stiff Hindquarters? |
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If yes, when did symptoms start?
What time of day or year is your horse most stiff? |
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Does walking help? |
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I have the following herbal solutions
on hand now: |
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Additional Comments, Questions,and/or Concerns
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Many of you may be familiar with working with herbs and our Herbal Solutions and will not need either of these services to choose the best Solutions for your horse. If you have questions that Customer Service is able to assist you with, please feel free to call 866-537-7336 or email contactus@forloveofthehorse.com.
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