Equine Fax Horse Health Parameters Form

Owner: Cell:
Registration #:
Email:
Date: Time:
Horse:
Breed:
Age: Sex:
Color :

Tattoo/Microchip:
General attitude and demeanor:

Comments:
Appetite:

Comments:
Body Condition (1-9): 1 2 3 4 5 6 7 8 9
Skin and Coat

Mane and Tail:

Comments:
Movement:
LF:

RF:

LH:

RH:

Comments:
Head, face, throat looks and feels:
From front:

From sides:

Left eye:

Right eye:

Comments:
TPR (Temperature, Pulse, Respiration
Temperature:
Pulse:
Respiration:
Capillary refill time:

Mucous membranes:

Pulse feels:

Heart sounds:

Respiratory sounds:

Comments:
Gut Sounds:
Upper left side:

Lower left side:

Upper right side:

Lower right side:

Feet:
Heat 0-5   / Digital Pulse 0-5
LF: /
RF: /
LH: /
RH: /
Limbs look and feel:
LF:
RF:
LH:
RH:
Body, neck, and back look and feel:
Under belly looks and feels:
Tail and under tail look and feel:
Sheath or udder looks and feels:
Other notes: