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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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We understand that different caretakers have different needs and wants. 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. There is no charge for this service.
Others of you may prefer more in-depth guidance for choosing the best Herbal Solutions for your horse. For this reason we offer the following two informational Support Services to assist you:
- Herbal Solution Protocol: Based on the information you provide, we will determine the best herbal solution protocol for your horse’s recovery and send it to you either by email or postal mail. The cost for an email or postal mail evaluation and protocol recommendation is $10.
- Phone Evaluation/Consultation: If you prefer you may request a phone evaluation/consultation. This service would be best for caretakers who would like to discuss their horse’s health history and current profile before deciding on an appropriate Herbal Solution Protocol for their horse’s recovery. The cost of the phone evaluation/consultation is $25
Phone Evaluation/Consultations are scheduled Monday through Friday between 10:30 a.m. and 5:00 p.m. EST – please indicate your preference(s). We will contact you to schedule the evaluation/consultation.
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Please choose your preference: |
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The Following Blood Panel Evaluations Services are only available for horses with Equine Metabolic Syndrome or Malabsorption Syndrome:
Blood Panel Evaluations
The blood panels that Dr Thomas requires for an accurate Blood Panel Evaluation are specific and differ from many of the blood panels conventionally used for horses with this metabolic syndrome. Refer to the Blood Panel Fact Sheet under Quick Links on "Services" page of the web site or call customer service to request one.
We offer two options for you to have a Blood Panel Evaluation for your horse.
- Basic Blood Panel Evaluation – Dr. Thomas will evaluate the blood panel information that you submit; provide a concise summary of his findings and a custom herbal solution protocol based on this evaluation for your horse. The cost of his evaluation is $50 and the written protocol is $10
- Blood Panel Analysis and Interpretation – In addition to the blood panel evaluation and herbal solution protocol recommendation, Dr. Thomas will provide you with an in-depth written Blood Analysis and Interpretation. The cost of the full Blood Panel Analysis and Interpretation is $150
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Please choose your preference: |
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