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Donated Equine Questionnaire
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Owner"s Name
*
First
Last
Horses Registered Name/Barn Name
*
Breed
If Registered - Association Name & Registration #
Is the horse Tattooed (Lip or other) or Branded (Info)
Gender
Mare
Gelding
Stallion
Age or Approximate Age
Height (in Hands) / Ponies (Inches)
Weight - Overweight, Underweight, Good, Thin, Skinny
Color & Markings
Temperament & Training Information -Using 1-10,.........10=(Friendly or Spirited)
How Long Have You Owned This Equine
Temperament 1-Very Quiet .................. 10-Very Spirited
Selected Value:
0
Friendliness with People 1-Nasty/Afraid .................. 10-Very Friendly
Selected Value:
0
Friendliness with Other Horses 1-Nasty/Afraid .................. 10-Very Friendly
Selected Value:
0
Friendliness with Dogs 1-Nasty/Afraid .................. 10-Very Friendly
Selected Value:
0
Does This Horse Have a History of
Bucking
Kicking
Rearing Up
Biting
Other (Explain below)
Horse History (Any Issues/Problems)
Is This Horse Easy to
Lead
Tie
Trailer
Clip
Can This Horse Be Ridden By
Can NOT Be Ridden (Young/Not Trained)
Can NOT Be Ridden (Lameness/Injury/Old Age)
Light Weight At Walk (Under 75 lbs)
Adult Weight At Walk (Over 75 lbs)
Light/Medium Riding
No Limitations For Riding
Has This Horse Been Ridden or Had Experience In
Trail Riding / General Western
General English / Dressage
Driving
Youth Horse
Eventing / Endurance
Housing / Health
What type of housing is this horse used to?
Mostly Stalled
Daily Turnout for a Few Hours
Pasture with Shelter
Pasture without Shelter
What type of fencing is horse used to?
Board
Tape
Electric Wire
Farm Fence
What type (if any) of grain and how much is horse fed
What Type and how much is the equine fed (Alfalfa, Grass, Free Choice Round Bale, Flakes)
Describe any current or previous health problems:
Does the equine have any special needs?
Is the equine on any type of supplements or medications?
Describe any current or previous lameness problems:
Is the equine current on vaccinations? Who administered Vaccines?
Owner gave vaccines
Veterinarian gave vaccines
Eastern/Western Encephalomyelitis
Tetanus
Rhino/Flu
West Niles
Potomac (PHF)
Rabies
Strangles
Does this equine have a current coggins test?
Yes - a copy will be needed
No
Date and Product of last deworming or fecal testing/results
Date of last type teeth were floated
Date of last sheath cleaning / udders cleaned
Date of last farrier visit
General Information
Owner's Name
*
First
Last
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home or Cell Phone
Work Phone
Veterinarian's Name
*
First
Last
Veterinarian's Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Veterinarian's Phone
Is there anything else you can tell us about the equine that will enable us to help find him/her the best possible home? Additional Information can be emailed or sent with horse if transferred to Indiana Horse Rescue.
Name
Submit