Donated Equine Questionnaire – Indiana Horse Rescue

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

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

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?

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

State

Zip Code

Home or Cell Phone

Work Phone

Veterinarian's Name *

First

Last

Veterinarian's Address

Address Line 1

Address Line 2

City

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.