Thank you for taking a few minutes to complete this form. Hoofbeats Equine Wellness will not diagnose any specific issues or ailments before, during or after Equiscope sessions. The information you provide here will only be used to help guide the application of the Equiscope prototocols.
Animal Name
Client Name
Sex:
Age
Breed
Why you are seeking Equiscope thereapy for your horse? (Ex: injury, pain management, overall wellness etc.)
What happened and/or when did you first notice this issue?
Has your horse had any of the following diagnostics for this particular issue?
Please select all that apply.
May I be in contact with your veterinarian regarding this issue?
If yes, please provide your veterinarian's name and phone number.
Is your horse currently on any medication(s)? If so, please list the name(s) and frequency below.
Equiscope therapy can be detoxifying, so we'll need to plan accordingly so that medications are not flushed out of the body.
Does your horse have a history of any of the following?
Please briefly share any previous/relavent injuries or health issues not yet mentioned.
Is there anything else you would like to share about your horse at this time?