New Horse Intake

Your horse’s history & information is important during the massage therapy assessment phase and to help see progress and changes as they happen in your horse.

Owner's Name(required)

Horse's Name(required)

Email(required)

Age, Breed, Height(required)

Length of time that you have owned (or leased) this horse(required)

Primary & secondary discipline(s) that your horse performs(required)

Describe your horse's competitive season if applicable:

Any injuries, performance issues, or concerns? (required)

Primary reason for seeking these services?(required)

I AM ALLOWING EQUI-SMART AND ALL PERSONS CORRELATED TO THE COMPANY TO ASSESS, TREAT, AND CUSTOMIZE A PROGRAM FOR MY HORSE. I AGREE TO HOLD THEM HARMLESS FOR ALL INCIDENTS THAT MAY OCCUR DURING THE TIME THAT EQUI-SMART IS PRESENT, OR DURING THE TIME THAT I AM CARRYING OUT THE ASSIGNED PROGRAM.(required)

I UNDERSTAND THAT MY HORSE MAY OR MAY NOT HAVE A FULL RECOVERY AS INTENDED, AND AGREE NOT TO HOLD EQUI-SMART RESPONSIBLE FOR ANY ISSUES WITH SOUNDNESS, INJURIES, LACK OF PERFORMANCE, OR OTHER UNINTENDED RESULTS.(required)

I AGREE TO SEEK VETERINARIAN ADVICE FOR ANY APPLICABLE CIRCUMSTANCES OR SCENARIOS, AND UNDERSTAND THAT EQUI-SMART'S ADVICE AND SERVICES DO NOT REPLACE VETERINARY CARE AND ARE NOT CONFIRMED DIAGNOSES OF ANY INJURIES OR CONDITIONS.(required)

I AGREE TO ALLOW EQUI-SMART TO TAKE PICTURES AND VIDEOS OF MY HORSE AND THEIR TREATMENT, PRIMARILY AS A METHOD OF MAINTAINING RECORDS, BUT I ALSO UNDERSTAND THAT THE PICTURES AND VIDEOS MAY BE SHARED FOR TRAINING PURPOSES WITH OTHER MASSAGE THERAPISTS OR STUDENTS IN CLASSES. (required)

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