Please upload your pictures and videos here.

Please fill out the form to the best of your ability.

Name

First Name

Last Name

Patient/Horse Name

What type of concern is this?

This is an acute concern (this has recently come about)

This is a chronic concern (this has been going on for a while/TREVS has seen us for this

This is a recheck or follow up from a previous appointment with TREVS

This is a recheck or follow up from a previous or other veterinarian or clinic

If your horse has been seen by another veterinarian or clinic, does Tumalo Ridge Equine have records and history?

Has your horse been given medication for this concern?

If yes, what medication was given and when?

Please explain what is going on with your horse below. Please be as descriptive as possible.

I understand that TREVS may not be able to respond quickly. I have permission to share and upload the files above, I am the rightful owner of said files. I understand that this form is not intended for emergency cases.

Date

YYYY

I agree to electronically sign this document by typing my name.