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Client Assessment
First Name
Email
Work Phone
Street Address
State
Last Name
Phone
Referred By
City
Zip Code
Have you ever thought about the constant toll you take on your horses? How they work for you and at what cost?
Yes
No
What do you do to keep them healthy and happy? (select all that apply)
Supplements
Nutritious Snacks
Exercise
Daily Grooming
Massage/Body Work
Chiropractic
Acupuncture
Animal Communicator
Energy Work (I.E.;Reiki, Healing Touch etc.)
Seasonal Vet Care
Proper Foot Care
Proper Dentistry
Proper Saddle Fit
Healthy Pasture/Paddock
Safe Turnout/Pasture
Emergency Plan
If you selected Massage/Bodywork above, what types of massage or bodywork has your horse received? (Select all that apply)
Deep Muscle/Tissue
Sports Massage
Swedish Massage
Lymphatic Drainage
Reflexology
Touch For Health (Kinesiology/Taping)
Feldenkrais Awareness Through Body Movement
Alexander Technique
Yoga/Stretching
TTouch
Other
Which method did not work for you or your horse?
Do you personally receive massage or bodywork. If so, what types? (Select all that apply)
Sports Massage
Swedish Massage
Lymphatic Drainage
Reflexology
Touch For Health (Kinesiology/Taping)
Feldenkrais Awareness Through Body Movement
Alexander Technique
Yoga/Stretching
Other
Which method did you find delivers the best results for you personally?
When it comes to riding performance, what struggles does this horse, or horses presently experience when riding? (select all that apply)
Intermitten Lameness
Trouble With Girthing
Difficulty Picking Up The Correct Lead
Refusing To Move Forward
Shoulder Dropping In
Stiffness In The Hind Quarter
Lackluster Coat (Dull Or Coarse)
Skin Issues And Sensitivities
Tender At The Poll
Ear Sensitivities
Refusing Jumps
Other
When it comes to riding or performance, what physical struggles are you presently experiencing while riding? (select all that apply)
Sore Knees After Riding
Low Back Pain
Numbness Or Tingling In Hands And/Or Feet
Wrist Pain
Hip Joint Pain
Neck Pain And/Or Headaches
Sinus Pressure
Abdominal Pain
Perineum Or Groin/Pelvic Floor Pain/Achiness
Other
What goals, dreams, desires with your horse would you like to accomplish?
Thanks for submitting your Client Assessment Form! We'll get back to you soon.
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