EmailMe Form - Request an ONLINE CONSULTATION

Your Name *

First Last

Your Email *

Horse Name *

If the horse does not have a Registered Name, please enter Barn Name.

Have we Seen or Consulted on This Horse Previously? *

YES

NO

What is the Nature of Your Request? *

My Horse is Lame

My Horse is Sick

I Have Questions About Surgery

I Have Questions About Trimming and/or Shoeing

Photographic Review

Video Footage Review

Diagnostic Image Review (Radiographic, Ultrasonographic, Scintigraphic, etc.)

I Want a Second Opinion

OTHER

*Please Click ALL that Apply

Client CONTACT INFORMATION

The following must be completed for Non-Regular Clients of The ATLANTA EQUINE CLINIC:

Your Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Your Phone Number

### - ### - ####

HISTORY

Please provide us with a detailed history of your horse's problem(s).

HISTORY

*Please include the SIGNALMENT of your Horse (Age, Breed, Gender, Color, Weight, Discipline, etc.)

ASK Your QUESTIONS

Please let us know exactly what information you are seeking so that we can satisfy your request.

QUESTION(S)

*Pertinent photographs, video clips, medical reports and/or diagnostic images should be submitted separately. Please see our Dropbox® Link for Image Submission.

Attach Image or Report

Multiple files should be submitted separately. Please see our Dropbox® Link.