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Manchester Equine Therapy Booking Form
Equine Sports Massage Booking Form
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* Indicates required question
Email
*
Your email
Name:
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Your answer
Home Address:
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Your answer
Telephone Number:
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Your answer
Horses Name:
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Your answer
Age:
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Your answer
Sex:
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Your answer
Breed:
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Your answer
Height:
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Your answer
Colour:
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Your answer
Livery Yard address:
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Your answer
Veterinary Surgeon:
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Your answer
Does your horse have any history of the below (please tick all that apply):
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Cancer
Lameness (intermittent or other)
Illness (viral infection, strangles, colitis, colic, azoturia, EIPH, grass sickness, etc)
Surgery (colic, injury etc).
Pregnancy
Arthritis
Infection
Injury (Trauma, tendon rupture, open wound etc)
Other:
Required
If you have selected 'Other', please give details below.
Your answer
Does your horse have any on-going issues which need to be noted i.e. cold backed, resistant to work, weaving etc.
*
Your answer
By ticking the checkbox below, I understand that I have not requested assessment or treatment by Manchester Equine Therapy for any acute or chronic lameness, illness, injury or ailment which requires veterinary attention prior to the application of therapeutic massage therapy. Any and all past and current health conditions have been disclosed in the above information. I understand the sports massage treatment performed by Manchester Equine Therapy will be for therapeutic purposes only. I understand that massage treatment will not be carried out should the horse have a contraindicated condition to performing massage therapy:
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I AGREE
Required
I consent to my information being held purely for record keeping purposes only and understand it will not be passed to any third parties. Details of any treatment may be shared with veterinary surgeons and other equine professionals on request:
*
YES
NO
Required
A copy of your responses will be emailed to the address you provided.
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