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L.I.F.E.'s Veterinarian Investigation Form part 1 of 3


EQUINE COMPLAINT VETERINARIAN REPORT
DATE OF REPORT INDIVIDUAL ID. NO. REPORT TAKEN BY

NOSE EYES SKIN PULSE RESP. COUGH FECAL URINE TEMP
NOSE: D discharge, C Clear. EYES: D discharge, C Clear, GL glassy, U ulcer. SKIN: N normal, DA dandruff, D dull/dry, EC eczema, RW ringworm. PULSE: N normal, IR irregular, R rapid, S slow, W weak, SH shallow. RESP: N normal, R irregular, R rapid, S slow, SH shallow. COUGH: 0 none, S slight, SH shallow, DE deep. URINE: N normal, 0 none, CL cloudy, D dark. FECAL: N normal, 0 none, C constipated, D diarrhea, WD watery diarrhea, DB diarrhea with blood.


Instructions: Check all which may apply:

SOUNDNESS

  • Bone Spavin
  • Capped Elbows
  • Capped Hocks
  • Contracted Feet
  • Curb (suspected)
  • Epiphysitis
  • Knocked-down Hip
  • Laminitis
  • Navicular Disease (suspected)
  • Popped knees
  • Quittor (suspected)
  • Ringbone (suspected)
  • Sesmoiditis
  • Sidebone (suspected)
  • Splints
  • Stringhalt
  • Windpuffs
  • Wobbler Syndrome



ANIMAL WEIGHT_________________


Tape_____Scale_____Sight_____



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DIET
Roughages: Amt. No. Fds
Alfalfa. .
Alfalfa/Grass hay. .
Alfalfa/Grain hay. .
Grass hay . .
Grain hay. .
Other hay. .
Hay cubes. .
Hay pellets. .
Complete pellet food. .
Grain: Amt. No. Fds
Oats. .
Corn. .
Barley. .
Sweetfeed. .
Other. .
Feed Supplements: Amt. No. Fds
Type. .
.. .
.. .
Vitamins/Minerals: Amt. No. Fds
Type. .
.. .
.. .
.. .
.____________ ____________



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