Name
*
Miss.
Mrs.
Mr.
Dr.
Ms.
Other.
Prefix
First Name
Last Name
E-mail
Are you a registered client of New Forest Equine Vets?
*
Yes
No
Address
House No: or Name
Street Address
City
County
Post Code
Phone
-
Area Code
Phone Number
Mobile
*
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INDIVIDUAL ANIMAL INFORMATION
Number of animals
1
2
3
4
5
Animal 1 Information
Name
Age
Horse, Pony Donkey?
Horse
Pony
Donkey
Does the animal live/graze on the open New Forest?
Yes
No
Any concurrent disease/medication
Yes
No
Please list
Do you know the date last wormed?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Do you know the date of last moxidectin treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Equest / Equest Pramox
Do you know the date of last tapeworm treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
e.g. Equest Pramox, Equitape, Double dose Stongid-P
Animal 2 Information
Name
Age
Horse, Pony Donkey?
Horse
Pony
Donkey
Does the animal live/graze on the open New Forest?
Yes
No
Any concurrent disease/medication
Yes
No
Please list
Do you know the date last wormed?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Do you know the date of last moxidectin treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Equest / Equest Pramox
Do you know the date of last tapeworm treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
e.g. Equest Pramox, Equitape, Double dose Stongid-P
Animal 3 Information
Name
Age
Horse, Pony Donkey?
Horse
Pony
Donkey
Does the animal live/graze on the open New Forest?
Yes
No
Any concurrent disease/medication
Yes
No
Please list
Do you know the date last wormed?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Do you know the date of last moxidectin treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Equest / Equest Pramox
Do you know the date of last tapeworm treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
e.g. Equest Pramox, Equitape, Double dose Stongid-P
Animal 4 Information
Name
Age
Horse, Pony Donkey?
Horse
Pony
Donkey
Does the animal live/graze on the open New Forest?
Yes
No
Any concurrent disease/medication
Yes
No
Please list
Do you know the date last wormed?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Do you know the date of last moxidectin treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Equest / Equest Pramox
Do you know the date of last tapeworm treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
e.g. Equest Pramox, Equitape, Double dose Stongid-P
Animal 5 Information
Name
Age
Horse, Pony Donkey?
Horse
Pony
Donkey
Does the animal live/graze on the open New Forest?
Yes
No
Any concurrent disease/medication
Yes
No
Please list
Do you know the date last wormed?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Do you know the date of last moxidectin treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
Equest / Equest Pramox
Do you know the date of last tapeworm treatment?
Yes - exact
Yes - approximate
No - Unknown
Please enter date
e.g 14/02/2017 or Feb 2017
Product used
e.g. Equest Pramox, Equitape, Double dose Stongid-P
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HERD INFORMATION
Total number of animals in herd
Any Donkeys?
Yes
No
Any sheep/cattle co-grazing?
Yes
No
Stocking density (number of animals per acre)
Less than one
one
More than one
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PASTURE MANAGEMENT
Are fields poo-picked 2+ times per week?
Yes
No
Are paddocks rotated in summer?
Yes
No
Are paddocks harrowed?
Yes
No
Time of year / weather conditions when harrowed
e.g Summer, dry
Is muck heap within pasture?
Yes
No
Are neighboring fields managed similarly?
Yes
No
Details
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WORMING PRIORITIES
Priorities for your worming programme (select all that apply)
Minimal Drug Use
Reduce Risk of Wormer Resistance
Most Environmentally Friendly
Cost
Ease of administration
Any other comments?
Should be Empty: