Owner Full Name
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Horse's Name
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Horse's Age
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Horse Breed
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Horse's Height
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Horse's Discipline
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Main Veterinarian's Name
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Main Veterinarian's Phone Number
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Please list any other veterinarians, bodyworkers, chiropractors, massage therapists, osteopaths, ect.
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Please list any medications and supplements that your horse is currently receiving or has recently been given:
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Please list all known injuries and illnesses the horse has had:
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Please list any surgeries and x-rays the horse has had:
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Is there anything else that you'd like me to know about your horse?
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