New Equine/New Injury Information
This form is for New Equine patients of Collar and Saddle or Existing Equine patients with a new complaint and/or returning more than 1 year since their last visit.
If you have multiple animals to be seen: Please be sure to include YOUR name on this form, but you do NOT need to re-enter your address and phone number on subsequent forms for each animal.
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Equine Fee Schedule: New Patient/New Injury/1+ year since last visit: $150, Existing patient/Follow up visits: $120, Travel Fee ($1/mile over 10 miles from Midlothian center), Multi-Animal discount available ($30/additional equine)
By checking this box, I acknowledge that I understand the current fee schedule outlined above.
I understand that fees are due at the time of service.
Client (Owner) Name
Client Email Address
Address (Please include zip code)
Veterinarian's Email (if known)
Breed (list any known)
Select Chief Complaint
No Complaint (Wellness Chiropractic)
Not Picking Up Lead
Change In Behavior
Not Driving From Behind/Not Engaging Hind
Explain Above or List Additional Concerns
When did this (these) issue(s) begin?
This issue came on...
Mechanism of Injury (How this issue began)
Riding in trailer
Getting in/out of trailer
Wrong saddle fit
History of trauma/injury
Other (please specify below)
Explain above or list other specific method of injury.
Past Surgeries (excluding spay/neuter)
Previous X-rays/Other Imaging Tests/Information
Additonal Information you feel may help us help your animal:
The State of Texas REQUIRES us to have a veterinary referral to see your animal. Please watch your email inbox for a DocuSign consent form for both you and your animal(s) veterinarian to sign. We may first need to locate your Veterinarian’s contact info, so please allow time for us to obtain this info.
We look forward to working with you and your veterinarian to help your animal feel and function their best!
Collar and Saddle Staff
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