Fresh Start Application Form

Fresh Start Application Form
Client Name*

First NameLast Name
Contact number*
Email *
example@example.com
Address where you wish to arrange your Fresh Start Initial Consult*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are there any medical conditions, injuries or social characteristics of the rider or handler that I should be aware of? *
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Section A. This section asks for general information about your horse and an over view of any problems you are experiencing.
Horse Details:*

I am the owner of the horse detailed belowI have permision from the owner to arrange a consultation.
Horse's Name, Age and Gender *
Length of time with current owner/ carer*
Length of time on current yard*
What issues are you experiencing with your horse? (Please give an overview of anything you feel is relevant - specific behaviours are looked at in the following sections)*

Section B. These questions are about your horse's health, lifestyle and other professionals input. They help by indicating which areas have already been investigated as a cause for behaviour.
When was the horse last seen by a vet?*
Has the horse been seen by a vet by anything other than routine procedures? If Yes please give details*
Frequency of farrier visits?*
Has the farrier had any concerns regarding the health of the horse’s feet or foot balance? *
Date of last dental check*
Has there ever been any work required other than routine dental care? If yes please give details. *
Date of last musculoskeletal /physical therapist visit*
Have therapists had any concerns regarding the horse’s muscle tightness or movement pattern? Has a strength and conditioning or rehabilitation plan been put in place, and if so have you been able to undertake this work confidently? If your therapist has advised the horse be examined by a vet please indicate that here. *
Date of last saddle fitting?
Was the saddle checked by a qualified saddle fitter? Did the saddle fitter have any concerns with the horse's fitness, condition or movement pattern with regard for the ridden work required, or discuss any complications with regard to fitting a saddle to the horse's shape or way of going?*
Condition scoring. Is the horse currently in poor, good or overweight condition?*
Please give details of the horse’s lifestyle (time spent in, time spent out, enrichment offered and an overview of the environment)*
Does the horse have a field companion? How does the horse behave towards other horses?*