EmailMe Form - Equine Weight Loss Questionaire

Horse's Name *

Age *

Breed *

Sex *

How long have you noticed
your horse losing weight? *

Please describe your
horse's current diet. (Hay,
grain. Which brand/type,
how much, how often?) *

What medications or
supplements does your
horse currently receive? *

How many hours/day does
your horse have access to
pasture? *

Which of the following best
describes your horse's pasture. *

Lush, more than enough to eat, few weeds.

Sufficient, it gets eaten down a bit and grows some weeds.

Sparse, room to move but not much to eat except weeds.

Dirt lot, for exercise only.

n/a, my horse is stall bound

Describe your horse's
current work load. Has this
recently changed? If so, how? *

When were your horse's
teeth last examined/floated? *

Describe your horse's
deworming program (how
often, which brands of
dewormer) Be sure to
include the date when
he/she was most recently
dewormed and with which
product. *

Which of the following best
describes your horse's
normal fecal output. *

Does your horse have any
chronic conditions/medical
issues? (arthritis, lameness,
neurologic dysfunction,
EPM, Cushing's disease,
pregnancy, etc.)

Has anything in your horse's
life changed since or just
previously to your noting
weight loss? (Changed
barns, feed, exercise
routine, loss of a
pasturemate etc.?) If so,
please describe. *

Please describe any other
factors you believe may be
contributing to your horse's
weight loss.