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.
Sign in to Google to save your progress. Learn more
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) *
Required
Client (Owner) Name *
Client Email Address *
Phone Number *
Address (Please include zip code) *
Animal Name *
Veterinarian Name *
Veterinarian's Email (if known)
Gender, Intact/Neutered/Spayed *
Breed (list any known) *
Color *
Select Chief Complaint
Explain Above or List Additional Concerns
When did this (these) issue(s) begin?
This issue came on...
Clear selection
Mechanism of Injury (How this issue began)
Explain above or list other specific method of injury.
Past Surgeries (excluding spay/neuter)
Current Medications/Supplements
Previous X-rays/Other Imaging Tests/Information
Previous Care
Additonal Information you feel may help us help your animal:
Permission Form
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
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy