1. Program Horse Intake

To be completed by the horse owner.

Thank you for offering your horse to our therapeutic program. This is a full and comprehensive questionnaire, which is the initial stage to help us determine if a horse may be suitable. Potential horses are then brought to our facility for a trial period to assess their fit within our therapeutic programs. Please take the time to complete this questionnaire to the best of your knowledge.

Yes, I have a horse that I would like to offer to LTRA's therapeutic program. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Horse Questionnaire

Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name of horse {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Gender {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Height {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Breed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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How long have you owned this horse? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Please describe when, and the type of work, this horse has been used for: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Where does your horse fall in the pecking order of the herd? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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We would like to ask a very important question. Why do you feel your horse would make an ideal therapeutic horse and fit into our very unique program? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

The following questions will outline the condition of your horse:

Is the horse sound? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If no please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Is the horse physically fit? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If no please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Has your horse ever had founder? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If yes please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Has your horse ever had a serious illness? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If yes please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Has your horse ever been involved in an accident? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If yes please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Regular deworming schedule? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Any deworming issues? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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What deworming products have been used, and on what schedule? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Regular vaccination schedule? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Any vaccination issues? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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What vaccination products have been used, and on what schedule? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Any allergies to medicines? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If yes please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Any allergies to feed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If yes please explain {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Is your horse easy to catch? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Is your horse easy to lead? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Are there any issues with being tied up? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Are there any issues with being tacked up? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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What kind of bit is your horse accustomed to? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Can this horse be ridden in a halter: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Has your horse worked in an arena? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Does your horse pick up feet willingly? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Any issues with trimming or shoeing? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Does your horse stand still for the following?

Mounting from the ground? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Mounting from a block? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Dismounting? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Has your horse ever been used for breeding? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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If available please add up to 3 recent photos: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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