<p> Equine Case History Questionnaire</p><p>Date of consultation: Case Number:</p><p>Pet Behaviour Therapy Ellena Hinson BSc (Hons) PGCE PG Dip CABC 01908 241418 / 07400 967307</p><p>Please answer the following questions accurately and in as much detail as possible. Questions continue over page.</p><p>Background information</p><p> Your name: </p><p> Address: </p><p> Daytime Tel No: </p><p> Evening Tel No:</p><p> Email address:</p><p> Address:</p><p>Equine details</p><p> Name of horse: </p><p> Breed/Type:</p><p> Age: </p><p> Sex: </p><p> Height:</p><p> Colour:</p><p> Date of birth:</p><p> Date of purchase:</p><p>Page 1 Equine Case History Questionnaire</p><p> Where is your horse kept?</p><p> Are you the primary caregiver or is the horse in part/full livery?</p><p> What is your previous horse owning experience? (i.e. how long, level of competence, any qualifications etc?)</p><p>Vet and Medical details</p><p> Vet name: </p><p> Practice address and phone number:</p><p> When did the vet last visit and why?</p><p> Does the horse have any allergies?</p><p> Are there any past or present medical problems? Please describe in full</p><p> Is the horse currently on any medication?</p><p>Purchase information</p><p> How long have you owned the horse?</p><p> At what age was the horse purchased?</p><p> What do you know about the horse’s history before you bought him/her?</p><p> Why did the last owner sell him/her?</p><p> Why did you choose this horse?</p><p> Is he/she still used for the purpose you bought him/her for?</p><p>Early experience</p><p> What are the circumstances at birth? (Where there any complications, did the foal have company other than the dam etc)</p><p> How was he/she weaned?</p><p> What age was he/she weaned?</p><p> Training after breaking?</p><p>Page 2 Equine Case History Questionnaire</p><p>Sexual history</p><p> If male, is he gelded?</p><p> Is yes, at what age?</p><p> What is the breeding history? (Any foals)?</p><p> If female, how regular are her seasons?</p><p>Social interactions</p><p> Do you own any other horses (breed, height, gender, age obtained, age now)</p><p> Does this horse have interaction with these other horses?</p><p> How do they interact? (do they play, fight, groom one another, ignore each other)?</p><p> What people are involved with the horse and how do they get on?</p><p>Daily routine</p><p>Please describe 24 hours in your horse’s day:</p><p>Does this routine vary with weekends and holidays?</p><p>Does it vary at different times of the year?</p><p>Describe the type of housing your horse has</p><p>How much exercise does your horse yet?</p><p>Page 3 Equine Case History Questionnaire</p><p> How much is ridden, lunged, jumping, hacking, in field or arena?</p><p> How does the horse behave at shows/on hacks/in traffic?</p><p> Describe in detail your horse’s diet:</p><p> How many hours per day/per week does your horse spend at grass?</p><p> What size is the field?</p><p> Are there any other horses turned out with your horse? How many?</p><p>Handling</p><p>What is your horse like to?</p><p> 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</p><p>How does the horse react to strangers (in stable and or in the field)?</p><p>Page 4 Equine Case History Questionnaire</p><p>The problem</p><p>Describe in detail the problem behaviour</p><p>What happens immediately before the behaviour?</p><p>What happens immediately after the behaviour?</p><p>How serious would you say the problem is?</p><p>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?</p><p>Has the problem got worse? </p><p>Can you remember when it started? Describe in detail the FIRST time it ever happened</p><p>How did you react?</p><p>Was there anything else that happened at this time?</p><p>Describe in detail the most recent 3 incidents, including the following information:</p><p>- Where was the horse?</p><p>- What was it doing before the incident?</p><p>- Who else was present?</p><p>- How did they react?</p><p>- Was the animal punished? How? How did it react?</p><p>Page 5 Equine Case History Questionnaire</p><p>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.</p><p>Page 6</p>