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Equine Questionnaire
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Barn Name/Nickname |
Registered Name |
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Current Owner |
Vet |
| Address |
Address |
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City, State, Zip |
City, State, Zip |
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Day Phone |
Phone |
EQUINE INFORMATION
PLEASE ATTACH REGISTRATION PAPERS
| Breed of animal you are donating |
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Is the animal registered? |
Date Foaled/Age
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Height
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Gender
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Color
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| Description |
| Markings |
Does the animal have a tattoo or brand? If so, what & where is the tattoo?
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MAJOR MEDICAL ISSUES WITHIN THE LAST THREE YEARS (IF AVAILABLE)
Are there any urgent medical needs or injuries that require immediate attention?
Please list all:
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May APC/IHR contact the Vet(s) listed? |
Please request the horse’s medical records be sent to APC/IHR or authorize
release of the medical records to APC/IHR. |
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Temperament (1-10)
1=Very Quiet, 10=Highly Spirited)
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Friendliness with adults
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(1-10)
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Friendliness with children
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(1-10) |
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Friendliness with horses
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(1-10) |
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Friendliness towards dogs
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(1-10) |
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Friendliness towards cats
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(1-10) |
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FARRIER
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Last farrier date |
Trimmed/Shod |
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Type of shoes/devices |
Reason for corrections |
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Does the horse stand for farrier? |
Comments |
HEALTH
| Last vaccination date |
Vaccines |
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Last worming date |
Wormer |
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Last time teeth were floated |
Last time sheath or udders were cleaned? |
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Current medications/special care |
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How often |
Why |
Please list all known medical problems/conditions (allergies, spavins,
navicular, broken bones, heaves, splints,
etc.
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If a mare, has she ever been bred?
How many foals?
Last breeding? |
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If horse is a gelding, when was he gelded? |
Can this equine be ridden by: (circle all that apply)
| Not ridable: injury/age |
Not ridable: old age |
Not ridable: age/training |
| Children at walk |
Adults at walk |
light/medium riding |
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Comments |
FEEDING
| Current feeding pattern: |
| Pasture: |
Type: |
Hours per day: |
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Hay type: |
Amount: |
Frequency: |
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Grain type: |
Amount: |
Frequency: |
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Supplements or special feed? |
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Comments: |
SHELTER
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Pasture only |
Stall |
Run |
Turnout Hours per day: |
If not now in pasture, has the horse ever been pastured?
How long ago? |
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What type of fencing has your horse been in? |
TRAILERING
| Has the horse ever been trailered? |
Does the horse load easily? |
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Trailer type used: Stock
Side-by-side Slant Other |
How do you load the horse if there are problems?
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Comments
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BEHAVIOR
Is the horse hard to catch? If yes, how do you catch the horse?
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Known behavior problems |
cribbing |
weaving |
pacing |
biting |
| Comments |
| Does this horse have any other behavior
problems (kicking, rearing, biting)? |
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Comments |
TRAINING
| Type of training |
Length of time
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Trainer
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| Customary tack and bit used (bosal, hackamore, snaffle, etc)
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Tack or training aids
likes:
dislikes: |
Type of activity (circle all that apply):
| Western Pleasure |
Trail |
Reining |
Cutting |
Roping |
| Stock/Ranch work |
Driving |
Gaited |
Saddle seat |
Dressage |
| Hunter |
Jumper |
Other:___________________________ |
Is this equine easy to: (circle all that apply)
| Lead |
Tie |
Trailer |
Clip |
Other |
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Comments |
Reason for donating this horse to APC/IHR: __________________________________
Is there anything else you can tell us about the equine that will enable us to help find it
the best possible home?
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