Feline Case History Questionnaire

Equine Case History Questionnaire

Date of consultation: Case Number:

Pet Behaviour Therapy Ellena Hinson BSc (Hons) PGCE PG Dip CABC 01908 241418 / 07400 967307

Please answer the following questions accurately and in as much detail as possible. Questions continue over page.

Background information

 Your name:

 Address:

 Daytime Tel No:

 Evening Tel No:

 Email address:

 Address:

Equine details

 Name of horse:

 Breed/Type:

 Age:

 Sex:

 Height:

 Colour:

 Date of birth:

 Date of purchase:

 Where is your horse kept?

 Are you the primary caregiver or is the horse in part/full livery?

 What is your previous horse owning experience? (i.e. how long, level of competence, any qualifications etc?)

Vet and Medical details

 Vet name:

 Practice address and phone number:

 When did the vet last visit and why?

 Does the horse have any allergies?

 Are there any past or present medical problems? Please describe in full

 Is the horse currently on any medication?

Purchase information

 How long have you owned the horse?

 At what age was the horse purchased?

 What do you know about the horse’s history before you bought him/her?

 Why did the last owner sell him/her?

 Why did you choose this horse?

 Is he/she still used for the purpose you bought him/her for?

Early experience

 What are the circumstances at birth? (Where there any complications, did the foal have company other than the dam etc)

 How was he/she weaned?

 What age was he/she weaned?

 Training after breaking?

Sexual history

 If male, is he gelded?

 Is yes, at what age?

 What is the breeding history? (Any foals)?

 If female, how regular are her seasons?

Social interactions

 Do you own any other horses (breed, height, gender, age obtained, age now)

 Does this horse have interaction with these other horses?

 How do they interact? (do they play, fight, groom one another, ignore each other)?

 What people are involved with the horse and how do they get on?

Daily routine

Please describe 24 hours in your horse’s day:

Does this routine vary with weekends and holidays?

Does it vary at different times of the year?

Describe the type of housing your horse has

How much exercise does your horse yet?

 How much is ridden, lunged, jumping, hacking, in field or arena?

 How does the horse behave at shows/on hacks/in traffic?

 Describe in detail your horse’s diet:

 How many hours per day/per week does your horse spend at grass?

 What size is the field?

 Are there any other horses turned out with your horse? How many?

Handling

What is your horse like to?

 Tie up:  Lead:  Groom:  Handle feet:  Handle ears:  Worm:  Shoe:  Teeth rasping:  Vaccinations:  Mane pulling:  Bandaging/boots  General stable manners:  Catch in field:  General field manners:  Tack up:  Rug up:  Put headcollar on:  Lead in headcollar  Lead in a bridle:  Clip:  Load/travel

How does the horse react to strangers (in stable and or in the field)?

The problem

Describe in detail the problem behaviour

What happens immediately before the behaviour?

What happens immediately after the behaviour?

How serious would you say the problem is?

How often does it happen? Does it happen every time? For example, if you have difficulty leading, would you say it is all the time or at certain times?

Has the problem got worse?

Can you remember when it started? Describe in detail the FIRST time it ever happened

How did you react?

Was there anything else that happened at this time?

Describe in detail the most recent 3 incidents, including the following information:

- Where was the horse?

- What was it doing before the incident?

- Who else was present?

- How did they react?

- Was the animal punished? How? How did it react?

Thank you for your co-operation in filling in this questionnaire. If you have any queries, please do not hesitate to contact me on 07400 967307.