Equine Hospitalization and Surgical Release Form

MM slash DD slash YYYY
Name(Required)
Address(Required)
Best way to contact(Required)

Horse Information

DOB or approximate ag
Sex(Required)
Is your house insured?(Required)

Morning Feeding

Please describe what/how your horse should be fed while here at Colorado Equine Clinic.
e.g. grass, alfalfa, mixed, etc. and quantity
e.g. oats, senior, etc. and quantity
e.g. Myristol, Cal's Minerals, etc. and quantity
e.g. Equioxx, Isoxsuprine, and quantity

Evening Feeding

Please describe what/how your horse should be fed while here at Colorado Equine Clinic.
e.g. grass, alfalfa, mixed, etc. and quantity
e.g. oats, senior, etc. and quantity
e.g. Myristol, Cal's Minerals, etc. and quantity
e.g. Equioxx, Isoxsuprine, and quantity
During the DAYTIME, my horse should be kept:
OVERNIGHT, my horse should be kept:
You are welcome to visit your horse any time while at CEC. We ask that you please:
  • Ask permission before taking your horse from his stall.
  • Do not clean your horse’s stall. Observing manure is an important part of our exams.
Consent
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Please read before signing:(Required)
Please leave your halter with the office staff! We will store it for you until pick up. You are welcome to visit your horse any time while at CEC. We ask that you please: •Ask permission before taking your horse from the stall. •Do not clean your horse's stall. Observing the stall is an important part of our exams. Thank you!
This field is for validation purposes and should be left unchanged.