Important Instructions Please complete one form per client/location. If you have more than one horse to be trimmed, complete all answers with each horse in mind, clearly noting names when details differ. Example: • “Buddy is barefoot for 2 years; Daisy is recently pulled from shoes.” • “All three are on pasture 24/7. Only Rosie is on Omneity.” You may attach extra notes or pages if more space is needed. Client Information Name * First Name Last Name Phone (###) ### #### Email * Physical Address * Location of horses to be trimmed. Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing Address If different from physical. Address 1 Address 2 City State/Province Zip/Postal Code Country Preferred Contact Method: * Text Call Email Care Team & Emergency Contacts Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Relationship to Horse Owner * Veterinarian or Clinic * Vet/Clinic Phone * (###) ### #### Bodyworkers, Chiropractor, Trainer, etc * Please include your entire equine care team. Horse Information (Answer with all horses in mind. Distinguish differences between horses when needed.) Name(s): * Age(s): * 1-5 6-10 11-15 16-20 21-25 25+ Breed(s): * Sex: * Please list for each horse. Mare Gelding Stallion One or more horses are draft or oversized. * Please list names. Yes No Primary Discipline or Use * List for each horse. Last Trim Date(s): * Current Trim Frequency * Every 4 weeks Every 5-6 weeks Every 8 weeks When they need done Any Known Medical or Hoof Issues (lameness, injuries, imbalances)? * No observation is too small. No Yes - Please list horse(s) & concern(s) Behavioral Concerns or Handling Notes * No observation is too small. No Yes - Please list horse(s) & notes(s) Comfort Level Picking Up Feet: * All cooperative Some need support Hoofcare History Previous Hoofcare Provider * Shoeing History * Never shod Recently pulled shoes (within 6mos) Shod Regularity In Hoof Cleaning * Daily Weekly Occasionally Rarely Hoof Products Used * None Thrush Treatment Hoof Oil Hoof Polish Frog/Sole Dressing Hoof Packing Any Signs of Concern? * None Cracks Flares Thrush Abscesses Thin Soles Contracted Heels Underrun Heels Other Have any horses had hoof diagnostics done within the last year? * Yes No The appointment is made! Diet & Environment Feeding Program Dropdown Option 1 Option 2 Thank you!