For Love of the Horse Support Services Form

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	BARE FOOT HELP

	ADMINISTERING HERBS

	HELPFUL LINKS

	ARTICLES & STORIES

	GIFT CERTIFICATES

	FORUM

For Love of the Horse, LLC
215 North Street
Lathrop, Missouri 64465

866.Jesse.Doe (537-7336)
Fax: 816.528.3752

Email Us

Owner's Name
Address
City	State Zip
E-mail	Phone Fax
Today's Date

Horse/Pony Name	Breed Age
Sex	Approx Weight

Reason for contact
When did you first notice these signs/symptoms?

Feeding Program
List all Medications, herbs, or supplements being used
Recent Vaccinations

My horse/pony is	Barefoot Shod
Chronically Sore hooves?	Yes No
When and how often?
Examples of movement activity at present state
Examples of movement activity prior to ailment in question

Has your horse ever had a laminitic episode?	Yes No
Approximate Date of first laminitic episode
Treatment Program for the first episode

Date for Most Recent Laminitic Episode
Treatment Program used for the most recent episode

Does your horse/pony now or in the past have/had:
Edema/Fluid swelling in the chest, belly legs, shoulders?	Yes No
If yes, when, where and how often?
Distended Belly?	Yes No
If yes, when, where and how often?
Loose or liquid stool?	Yes No
If yes, when, where and how often?
Runny Eyes?	Yes No
If yes, when and what texture and/or color?
Runny Nose?	Yes No
If yes, when and what texture and/or color?
Loss of Appetite?	Yes No
If yes, when?
Stiff Hindquarters?	Yes No
If yes, when did symptoms start? What time of day or year is your horse most stiff?
Does walking help?	Yes No

I have the following herbal solutions on hand now:

Additional Comments, Questions,and/or Concerns
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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