Potential Horse Assessment FormPlease enable JavaScript in your browser to complete this form. - Step 1 of 5Owner InfoOwner InfoOwner's Name *Phone *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDonation or SaleSale Type *DonationFor SaleLeaseSale Price *NextGeneral Horse InfoHorse Info 1Horse's Name *Gelding or Mare? *GeldingMareHorse Info 2Breed *Height *Age *How long have you had the horse? *Horse Info 3Training/Background4-HShowsTrailEnglishWesternWhere is the horse kept? *Dry lotPastureStallHorse Info 4What does the horse eat? *What size herd is the horse in? *Horse Info 5Are they bossy or submissive? *YesNoExplanation *Any vices? (stall weaving, cribbing, pawing) *YesNoExplanation *Any behavioral issues? (bucking, rearing, bolting, biting) *YesNoExplanation *Horse Info 6Do they have any allergies? *YesNoDo they trailer well? *YesNoAre they easy to catch in the pasture? *YesNoPreviousNextHorse Health InfoSupplementsAny supplements? *YesNoAre the supplements required? *YesNoList of Supplements *VetCurrent Veterinarian Name *Vet Phone NumberMay we contact your vet to receive the records on this horse? *YesNoHealth ProblemsCurrent or Past Health ProblemsFounder/LaminitisColicArthritisHeaves/COPDNavicularBowed TendonsOtherOther Explanation *Is this horse up-to-date on shots? *YesNoVaccination DatesWE DateFLU DateRabies DateEE DateStrangles DateTetanus DateVE DatePHF DateOther DateWormingWorming Frequency *Date Last WormedProduct UsedDentalDate of Last Dental Exam *Any problems? *YesNoExplanation *PreviousNextFarrier InfoFarrier 1Farrier Name *Farrier Phone NumberFarrier 2Date of Last Farrier Visit *Any problems? *YesNoExplanation *Farrier 3Has this horse been lame in the past? *YesNoIs your horse... *ShoedBarefootPreviousNextMisc. InfoMisc 1Things this horse likes? (treats, scratch spots) *Things this horse isn't fond of? (ball, poles, bit, spurs) *Misc 2Why are you rehoming this horse? *Why do you think this horse would be a good fit for our program? *Is there anything else you would like us to know about this horse? *Signature *Clear SignatureThe information provided is complete and accurate to the best of my knowledge.Today's Date *Submit
