"*" indicates required fields Owner* Date* MM slash DD slash YYYY Time* Hours : Minutes AM PM AM/PM horse information*HorseBreedAgeSexColorHistory*Any prior problems? Use? Location & travel history last 6 months?Reason for WHE Today*Describe the problem you perceive? When did you first notice it?OBSERVATIONS FROM A DISTANCEGeneral Attitude & Demeanor:* Bright Alert Responsive (BAR) Quiet Alert Responsive (QAR) Lethargic Mildly Depressed Depressed NotesAppetite:* Normal Increased Decreased Not Eating Drinking* Normal Increased Decreased None Manure Amount* Normal Increased Decreased None Urine Amount* Normal Increased Decreased Don't Know Urine Appearance/Color* Normal Abnormal Don't Know Manure Appearance* Normal Diarrhea Soft-Cowpie Hard/Dry NotesPHYSICAL ASSESSMENTBody Condition Score (1-9) Condition/Quality of Skin & Coat* Excellent Good Fair Poor Condition/Quality of Main & Tail* Excellent Good Fair Poor NotesTemperature Pulse Respiration Gum Color (Mucous Membrane)* White/Pale Pale Pink Pink Red Purple/Blue Toxic Line Yellow Capillary Refill Time Almost Immediate 1-2 seconds 2-3 seconds over 3 seconds Skin Pinch - Hydration* Normal (snaps back within 1 second) Prolonged Pulse Feels* Normal Weak Irregular Cannot Feel Heart Sounds* Normal Murmur Irregular Cannot Tell Breathing Seems* Normal Abnormal Cannot Tell NotesGUT SOUNDSLeft Upper* Absent/Silent Less than Normal Normal Rumbling More than Normal Left Lower* Absent/Silent Less than Normal Normal Rumbling More than Normal Right Upper* Absent/Silent Less than Normal Normal Rumbling More than Normal Right Lower* Absent/Silent Less than Normal Normal Rumbling More than Normal Lowest-Belly* Absent/Silent Less than Normal Normal Rumbling More than Normal NotesHEAD, FACE, & EYESLook for asymmetry, swellings, injury, heat, or pain response.Head, face & throat look & feel* Normal Abnormal Left Eye* Normal Red Cloudy Watering Squinting Growth Right Eye* Normal Red Cloudy Watering Squinting Growth NotesLEGS & FEETLook for asymmetry, swellings, injury, heat, or pain response.Limbs look & feel* LF - Normal RF - Normal LH - Normal RH - Normal NotesFeet look & feelLF* Normal (Cool & No Digital Pulse) Warm or Hot Weak Digital Pulse Strong Digital Pulse RF* Normal (Cool & No Digital Pulse) Warm or Hot Weak Digital Pulse Strong Digital Pulse LH* Normal (Cool & No Digital Pulse) Warm or Hot Weak Digital Pulse Strong Digital Pulse RH* Normal (Cool & No Digital Pulse) Warm or Hot Weak Digital Pulse Strong Digital Pulse NotesOthersLook for asymmetry, swellings, injury, heat, or pain response.Body, neck & back look & feel* Normal Abnormal Under belly looks & feels* Normal Abnormal Tail & under tail looks & feels* Normal Abnormal Sheath or udder looks & feels* Normal Abnormal NotesHorse at MovementWalk straight away, turn sharp both left and rightLooks Normal Lame Wobbly Weak Stiff Reluctant Notes Please share your findings and concerns with your veterinarian EmailThis field is for validation purposes and should be left unchanged.