Home / Nutritional History ConsultationNutritional History Consultation Back to Consultations Nutritional Consultation History Step 1 of 6 – Getting Started 16% How did you find me? Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone(Required)Email Address(Required) Horse's NameAgeGenderMareGeldingStallionColtFillyBreedColorYears with OwnerImported?YesNoHandsApproximate Weight Owner Description of Issues(Required)Unusual Behaviors Licking Biting Eating Dirt or Manure Weaving or Cribbing Sensitivity to Touch, especially when brushing or tacking up Girthiness Bucking Rearing Other Please list "Other" Unusual BehaviorsReactions to Food Eager to Eat Eats Quickly Eats Slowly Picky Eater Leaves Food in Bucket How often fed? Once a day Twice a day Three times a day Four times a day Where is horse fed? Stall Field, secure from other horses Field, not secure from other horses How much hay does the horse get? (Type and how often)Each feed with weightWhat supplements does horse get? (List name, how much and how often) My horse is:Easy KeeperNormalHard KeeperThe mane condition:Thin and slow growingNormalFull and grows fastHorse's coat is: Short coat Delayed shedding Heavy coat Dull Normal Manure texture Normal Dry, packed together Smaller portions, more frequent Very wet and sloppy Energy level at rest Active Lethargic Energy level while riding Active Lethargic Hydration level (pinch skin fold at neck and point of shoulder). Does it return to baseline in < 3 seconds? Yes No Back above adrenals sensitive? Yes No Is your horse nervous or anxious? Yes No Does your horse tend to get allergies or infections? Yes No Is your horse more sensitive to flies that other horses? Yes No Does your horse attract more flies that other horses? Yes No Coat quality: Shiny and appropriate for season Inadequate winter coat Failure to shed in spring Dull and harsh Bleaches out in summer or winter Do your horse's eyes have:Check all that apply. Normal History of injury Infection Cloudy lens Uveitis Other Describe "Other" eye conditions.(Required)Your horse's teeth conditionCheck all that apply. Normal Missing teeth History of Mouth Infections Difficulty chewing Your horse's respiratory health is: Normal History of Respiratory Infections Breathing Disorder (Heaves) Your horse's gut health is:Check all that apply. Normal History of Colic History of Ulcers Diarrhea/Loose Manure Fecal Water Syndrome Your horse's feet: Strong, quickly growing Brittle and crack easily Slow growing, lack of heel growth Prone to abcesses Thrush, white line disease Your horse's skin is:Check all that apply. Normal Prone to allergic reactions Hives Fungal/bacterial infections (rain rot, scratches) Does your horse have joint: Normal, No Joint Issues Arthritis Injuries Other "Other" joint issuesTested for Lyme disease?(if yes, then please email titer report to 4oaksconsulting@gmail.com) Yes No If tested for Lyme, please email titer report. Which test was done?(Required)Tested for EPM:(if yes, then please email titer report and veterinary notes regarding neurological status to 4oaksconsulting@gmail.com) Yes No If tested positive for EPM, please email titer report. Describe the behavioral neurological exam findings.(Required)Please describe vaccination history.Please describe medication history for medications listed: Anti-inflammatories, Antibiotics, Antifungals, Ulcer medications, Topical medications, any other medications.Please describe worming history.Please describe dental history.Hoof care history Barefoot Shod Describe how often horse is seen by farrier, and any concerns or comments by farrier.(Required)Other care not listed above: Osteopathy Acupuncture Craniosacral Chiropractic Other Current exercise regimen:Not riddenLightly riddenModerately riddenHeavy intensityDays per week ridden:Minutes Ridden per RideAttitude tacking up:Attitude during ride:Horse's energy level while riding is:Check all that apply. Appropriate with sufficient energy Overly “up” and excited Spooks or startles easily Spooks or startles at familiar objects Tires easily Horse's current housing regimen:(Required)Check all that apply. Stalled Turned out on dirt lot or sacrifice field Turned out on small paddock with grass Turned out on large pasture with grass Other Water source: In stall In field Free choice loose salt? Yes No
