New Client Questionnaire
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Email *
Owner's Name *
Owner's Address *
Owner's Phone Number *
I am the current owner for this animal and have the appropriate authority to consent to treatment. *
Species * *
Name of Horse, Breed and Age *
Sex *
Occupation/Purpose? performance, pleasure, breeding, etc.
What is your main concern? *
Veterinary History and examinations for ANY reason. Please include dates for surgeries, tests, images, results, diagnosis and prognosis. *
When was your horse's last dental exam, and who is your dentist? *
When was your horse wormed last, and what did you use? *
Current medication and/or supplements? *
Who is your regular Veterinarian? Please include contact details. *
Any other relevant information regarding your horse's health? Please include any significant injuries/lameness in the past. *
Who is your farrier/trimmer? *
Who is your saddle fitter? *
Please read this carefully and press agree at the bottom if you understand and accept the following. Dr Rebecca Hill is a fully qualified and practicing Osteopath for Humans and has completed further education that permits her to practice Osteopathy on animals. Dr Rebecca Hill is NOT a Veterinarian and cannot assume primary care for this animal. Osteopathic treatment is a complimentary therapy and is NOT intended to replace veterinary care for this animal. I understand that Animal Biomechanical Medicine is a young profession and therefore research supporting the clinical applications of treatment to animals is minimal, and to contribute to the body of knowledge, some aspects of my animal’s care may be used in future research. While Rebecca has been fully trained to assess your animal, identify potential risks and chose techniques best suited to your animal and their safety, I understand that as with any treatment, there are risks involved. I understand that I can ask Rebecca about any risks involved with treatment and I know and understand that adverse reactions such as temporary soreness, changes in demeanour and behaviour, and stress responses can occur. More severe but less common adverse effects include lameness, colic, and more permanent worsening of symptoms. Dr. Rebecca Hill does not assume responsibility for the owner/handler of the horse at the time of the consultation. The owner/handler agrees to practice safe and conscious animal handling to minimise risk of injury to themselves and myself. I understand that all treatment and care provided by Dr Rebecca Hill is carried out in sincere good faith and the best of intentions for the care of the animal. *
Date of Agreement *
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