IWP Enrollment Questionnaire

Name: Brandon Equine Medical Center
Address: 605 E Bloomingdale Ave, Brandon, FL, 33511, United States
Telephone: 813-643-7177
Price range: $

Please fill out this form before your appointment.

Appointment Telemedicine

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Address where horse is kept *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Additional Phone

Horse's Name *

Sex *

Male
Female

Does he/she have a registered show name? *

Breed *

Age *

The above age is: *

Estimated
Exact/from papers

Does he/she have any tattoos or brands? *

How long have you owned him/her? *

Was he/she imported? *

Do you have plans to breed in the future? *

Does he/she have any vices (cribbing, weaving, etc.)? *

Does he/she have any behavioral concerns? *

Is he/she needle-shy? *

Has he/she ever been described as a “light-weight” for sedation? *

Is your horse currently on any medications? *

When were the last vaccines given, and what were they? *

Does this horse have a history of vaccine reactions? *

When was the last dental performed? *

Who performed the last dental? *

When/what was the last anthelminthic treatment administered? *

Was this based on a fecal egg count? *

Is he/she on a regular farriery schedule? *

Is he/she on a sand prevention program? *

Does the horse have a current Coggins? *

Is this horse microchipped? *

Is this horse insured? *

Does this horse have any history of colic? *

Has your horse been historically treated for unsoundness? *

Any history of surgery? *

Other relevant medical history? *

Any history of allergies to feeds, medications, etc.? *

Do you show or compete this horse? *

Does the horse ever travel for leisure (camping, trail riding, etc.)? *

Select the choice that best describes the horse's work load: *

Idle/occasional (less than 1x/week, primarily walking with occasional trot/canter)
Light (2-3x/wk, less than 20-40 min., light W/T/C or easy trail rides)
Moderate (4-5x/wk, 30-60 min, W/T/C with occasional jumping, pattern work, etc.)
Heavy (5-7x/wk, >60 min, regularly galloping, jumping, endurance, racing, etc.)

Please describe the horse’s diet (grain/hay amounts, # feedings/day): *

Please describe the horse’s turnout situation (grass/sand, size, hours per day, alone vs. with friends): *

Is the horse on any supplements? *

Would you be interested discussing holistic or complementary therapies for this horse? *

Message

Expert equine care in Brandon, FL.

From our board-certified horse surgeons and board-certified internists to our professional and courteous staff, at Brandon Equine Medical Center, we are committed to the health and well-being of all breeds and sizes of horses. In the field, as an outpatient, or when admitted to the horse hospital, we treat every horse like our own and every client as the most important.

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Contact Info

Phone: 813-643-7177
Fax: 813-643-5877
Email: info@brandonequine.com

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Hours

Monday – Friday: 8AM-5PM
Saturday & Sunday: Closed
Emergency care available: 24/7/365

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Location

605 E Bloomingdale Ave
Brandon, FL 33511
Click here for directions.

Have a question?

Our team is here to help! Complete the form below to get in touch.
If this is an emergency, please call us directly at 813-643-7177.

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