Hospital Admissions Form

Please complete our Hospital Admissions form before your horse's procedure

Contact details

Horse details

Horse admitted with:
Is your horse up to date with vaccines?:
May we clip your horse if necessary?:
Is your horse up to date with worming?:
Does your horse have any allergies?:
Is your horse shod currently?:
(Please be aware these need to be removed before surgery and MRI)
Does your horse have any habits?:
Does your horse have any known heart problems?:
Does your horse have any respiratory problems?:
Does your horse have any history of tying up?:
Is your horse signed out of the food chain in the passport?:
Is your horse on any current medication?:
In the last 30 days has your horse had symptoms of, or contact with, any other horses with infectious diseases such as Flu, Ringworm or Diarrhoea?:

Horse's Normal Routine

Preferred Bedding:
Normally turned out:

Insurance Details

Is your horse insured?:

Consent

Do you consent for us to use your horse's image/video for Pool House Equine Hospital publicity?:
 
Security Question: