Initial History Form

Once an appointment has been made please fill in the form below and send it to me before the massage appointment. If you have not yet made an appointment please call me to arrange a time and date that is convenient for you first. Please leave the signature box blank. Please fill in what you can on this form, if you cannot answer a question please leave the box blank.

I understand that massage or other modalities are never a replacement for proper veterinary care. I understand that the Equine Body Worker practitioner will not diagnose conditions, attempt any adjustments/musculoskeletal manipulations or prescribe medications, nutraceuticals or supplements for my horse. If my horse is currently being seen by a veterinarian, I have cleared this work with the attending veterinarian to ensure body work is at this time appropriate for the horse.