Equine Lameness Questionnaire Form

If your horse has founder or other lameness problems and you'd like to see how I can help you, fill out the form below. I'll review the information and contact you. I'm frequently on the road, so I'll respond as soon as I can. There is no charge for filling out the form or mailing it to me. It is for diagnostic purposes and will help save time getting details and background info. I will use the information to help customize a treatment and rehab program for your horse. Should you decide to allow me to take on your case, I will refer back to the data throughout the course of treatment. The initial consultation is free. Visit the Services page for a brief overview of fees. We will discuss fees, payment and duration of treatment during the initial consultation.

This form is intended to be comprehensive and thought provoking for the purpose of gathering as much data as possible to ‘paint a picture’ as to what your horse’s health is, how it’s been used and treated and to help establish a baseline for treatment from this point forward. Without knowing the following information, an accurate treatment cannot be developed for your horse. Each horse is an individual and the treatment must be tailored to fit each horse and each situation. Please take a take the time to fill out as much information as you can. The more information you can provide, the better the ‘picture’ you will paint and the clearer it will become as to how to best treat your horse. Actual photographs of your horse and its feet will be requested for additional data analysis.

Contact Info
First Name:
Last Name:
Email:
Address:
City:
 State Zip
Home Phone:
Cell Phone:
Best times to call:
Horse Info
Horse Name:
Age: years   Select: Height: Weight:
Breed:
How long have you owned this horse?
Where is this horse from and/or now live?
Feed
On an Emergency Diet?
if yes, describe & how long your horse has been on the diet.
Type and quantity of hay:
Type and quantity of feed:
Type and quantity of any supplements:
List any medications and dosages:
Environment
Describe your horse’s environment prior to founder / lameness
Stalled?
What size and for how long each day?
Stall flooring/footing:
Pastured?
How large, and how long each day?
Describe the terrain
(sandy, rocky, grassy, dirt, flat, hilly, etc.)
Exercise
What discipline(s)?
(Pleasure, trail riding, Dressage, Driving, Jumping, etc.)
Hand walked every day?
(if so, how long?)
Round penned?
(if so, how long and how hard?)
Frequently ridden?
(if so, how long and on what type surface and over what terrain?)
How often per week or month did you ride?
Hoof Ailment
Define and Explain your horse’s ailment (Founder, Laminitis, Navicular, etc.)
How long has your horse been lame?
How often has the lameness recurred?
Explain in detail what series of events too place leading up to the point of lameness.
Explain in detail what methods or treatments either the vets or farriers have applied.
(what type of shoes, pads, trims, impression material, etc.)
How long has each type shoe / treatment / protocol been used on your horse?
Health, condition, treatment and medications
Is your horse on Pergolide?
If so, how much and for how long?
Is your horse on Jiagulin?
(‘J’ herb) If so, for how long?
When was your horse’s last chiropractic adjustment?
When where the teeth last floated?
When was your horse’s last massage / stretching treatment?
How often and with what is your horse wormed?
When was your horse vaccinated last?
What was the last vaccine?
(what vaccines and were they all-in-one or spaced out individually over weeks?)
Has any blood work been done?
If yes, when and how often?
If yes, provide results of lab work.
When was your horse last detoxed?
How often is your horse detoxed?
What is / was used to detox your horse?
Is your horse a Cushing’s horse?
(if yes, was it confirmed?)
Was your horse confirmed Cushing’s prior to the founder / lameness?
Is your horse an Insulin Resistant (IR) horse? (if yes, is it confirmed?)
Was your horse confirmed IR prior to the founder / lameness?
When were last x-rays taken?
If possible, provide digital copies of all x-rays taken.
X-rays: Which views were taken?
(Hold down Ctrl to select more than one.)
X-rays: How was horse standing?
(Hold down Ctrl to select more than one.)
Were you present when the x-rays were taken?
Is / was your horse pregnant during or just prior to the founder / lameness?
Any known complications as a result of the pregnancy?
(retained placenta, aborted, bred yearly, etc.)
What is your horse’s current health status?
(skinny and weak, mostly strong and healthy, any pre-existing health issues or major injuries, etc.)
Has your horse ever had a tenotomy,
i.e. any tendons ever been cut to relieve founder?
If yes, which tendon(s)?
If yes, which leg(s)?
Has your horse ever had any type of major surgery? If so, what for?
Foot Health - please specify which feet
Do any feet vary in size from the rest?
if so, which one(s)?
What is your horse’s hoof shape / condition?
Club-footed?
Long toe / low heeled?
Splayfooted or pan caked?
Long footed with long heels?
Curled up at the toe like elf shoes?
Do your horse's feet look like 'healthy' normal feet?
Split, cracked, brittle or flaky?
Other? Explain.
What is the condition of the bottom of the feet? Brief descriptions are fine.
Sole of each foot:
Frog of each foot:
Bars of each foot:
What treatments or protocols have you administered or followed to aid your horse in the past?
For shoeing:
For abscessing:
For tendons (bowed, cut or otherwise):
For any illnesses:
How long did you try each treatment / protocol?
Do you have vet and / or farrier support?
Do you trim or shoe your horse yourself?
If so, how frequently and how long have you been doing so?
Explain in free text form, your horse’s current condition and / or situation and the most recent method of treatment, if not already explained above:
List or explain any other issues or concerns you feel relevant to the case that haven’t already been identified.

Keith Seeley
P.O. Box 872, Fortson, Ga. 31808
Phone: 770-312-6909
E-mail: keith@keithseeley.com
No distribution, reproduction or copies of any photos or text without express permission.
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