Register your horseHorse Intake FormPlease fill out this form as accurately as possible. Owner's Details First Name Last Name Your Email Phone Number Customer ID Where to find Order ID Where to find [cf7mls_step cf7mls_step-1 "NEXT" "Owner's Details"] Horse's Details Horse Name Horse Nickname Sire Name Dam Name Horse Sex MareStallionGelding Date of Birth Breed --SELECT BREED--ArabianThoroughbredQuarterhorseWarmblood varietyMorganPaint horseAppaloosaSaddlebredStandard bredNational ShowhorseMiniatureOther Color --SELECT COLOR--AppaloosaBayBlackBrownBuckskinChampagneChestnutCremelloDunGreyGrullaOveroPalominoPiebaldPintoRoanSkewbaldSmoky BlackTobiano [cf7mls_step cf7mls_step-2 "BACK" "NEXT" "Horse's Details"] Horse's UseShow/ CompetitionRacingBreedingWorkingPleasure[group ShowCompetition] Show/ CompetitionJumpingHunter JumpersDressageEventingSaddleseatReiningCuttingRodeoPoloFox HuntingHunt Seat EquitationWestern PleasureHunter PleasureHorsemanshipWestern DressageGymkhana[/group][group Racing] RacingFlat RacingJump Racing (National Hunt)Harness RacingSteeplechaseCombined DrivingBarrel RacingQuarter Horse RacingArabian Flat RacingEndurance Racing[/group][cf7mls_step cf7mls_step-3 "BACK" "NEXT" "Horse's Use"] Registration Entity--PLEASE SELECT--Jockey ClubArabian Horse AssociationAmerican Quarter Horse AssociationAmerican Paint Horse AssociationAmerican Warmblood RegistryAppaloosa Horse ClubFriesian Horse Association of North AmericaGypsy Horse Registry of AmericaAmerican Miniature Horse AssociationPurebred Morab Horse Association/Purebred Morab Horse RegistryAmerican Morgan Horse AssociationNational Show Horse RegistryPaso Fino Horse AssociationPinto Horse Association of America Inc.Pony of the Americas ClubAmerican Saddlebred Horse AssociationUnited States Trotting Association (Standardbreds)International Andalusian Lusitano Horse AssociationTennessee Walking Horse Breeders’ and Exhibitors’ AssociationWelsh Pony and Cob SocietyAmerican Trakehner AssociationOldenburg Horse Breeders SocietyAmerican Mustang and Burro Association Inc.International Andalusian Lusitano Horse AssociationLipizzan Association of North AmericaAmerican Hanoverian Society Notable Color Specific Registries--PLEASE SELECT--American Buckskin Registry AssociationPalomino Horse AssociationInternational Sport Horses of ColorNational Spotted Saddle Horse AssociationAmerican Cream Draft Horse AssociationInternational Champagne Horse Registry Warmblood Registries (US/North America)--PLEASE SELECT--American Warmblood RegistrySwedish Warmblood Association of North AmericaDutch Warmblood Studbook in North AmericaCanadian Warmblood Horse Breeders AssociationBelgian Warmblood Breeding Association/North American District Registration Number[cf7mls_step cf7mls_step-4 "BACK" "NEXT" "Associations"] DiseaseHealthyAbnormality of BloodOrthopedic / Lameness (Musculoskeletal/connective tissues)Muscle diseaseMetabolism/Endocrine systemReproductivePerinatal or birth issuesCardiovascular systemDigestive systemGenitourinary systemImmune systemSkin/ DermatologyNervous systemRespiratory systemCancer/neoplasm/tumorsBehavioral issuesFamily history of diseases[group AbnormalityofBlood] Abnormality of BloodAnemiaHemophilia AThrombocytopenia (Immune-mediated or medication induced)Blood clotting disorderLeukemia and Lymphoma[/group][group Orthopedic] Orthopedic / LamenessOsteochondritis dissecans (OCD)Juvenile osteoarthritisOsteochondral chip fracture (chip fracture)Condylar fractureCarpal bone fractureAngular limb deformityNavicular diseaseSoft-tissue injury (I would like to talk to the human docs about this more JH)[/group][group muscleDisease] Muscle diseaseHyperkalemic Periodic ParalysisStringhalt (Equine reflex hypertonia)ShiversSporadic Exertional RhabdomyolysisChronic Exertional RhabdomyolysisType 1 Polysaccharide storage myopathyType 2 Polysaccharide storage myopathyMalignant HyperthermiaRecurrent Exertional RhabdomyolysisIdiopathic myopathyGlycogen branching enzyme deficiencyImmune-mediated myositisMyotoniaFibrotic Myopathy[/group][group metabolismEndocrineSystem] Metabolism/ Endocrine systemObesity / insulin resistancePPID (Cushing's)HyperthyroidHypothyroid[/group][group reproductive] ReproductiveTwinsSpontaneous abortionsPlacentitisUmbilical cord torsionMare reproductive loss syndromeInfectious Placentitis (Herpesvirus, EVA, Bacterial, Mycotic)Difficulty conceivingPlacentitisProgesterone InsufficiencyDystociaStallion infertility[/group][group PerinatalOrBirthIssues] Perinatal or Birth IssuesNeonatal IsoerythrolysisSepsisNeonatal encephalopathyPrematurity/DysmaturityFailure of passive transfer[/group][group cardiovascularSystem] Cardiovascular SystemArrythmiasMurmurCongenital abnormalitiesVentricular septal defectPatent ductus arteriosusTetralogy of FallotTricuspid dysplasiaHeart failure[/group][group digestiveSystem] Digestive Systemgastric/foregut ulcershindgut ulcerscolicSpasmodicImpactionTorsion/VolvulusNephrosplenic entrapmentlipomasProximal GI EnteritisColitis[/group][group genitourinarySystem] Genitourinary SystemCystitis (bladder infection/inflammation)Pyelonephritis (Kidney infection)bladder/kidney stones[/group][group immuneSystem] Immune SystemImmune-mediated disordersImmunodeficienciesAutoimmune disordersAllergies[/group][group SkinDermatology] Skin/ Dermatologyinsect bite hypersensitivityHereditary equine regional dermal astheniaPapilloma (warts)Junctional epidermolysisIncontinentia Pigmenti[/group][group nervousSystem] Nervous SystemEquine degenerative myeloencephalopathyCervical stenotic myopathy (Wobblers syndrome)Occipitoatlantoaxial malformationSpina bifidaEquine protozoan myoencephalitis (EPM)Seizures[/group][group respiratorySystem] Respiratory SystemExercise Induced Pulmonary HemorrhageLaryngeal hemiplagiaDorsal displacement of the soft palateTracheal collapseRecurrent airway obstruction (RAO/COPD)Inflammatory Airway Disease (IAD)[/group][group cancerNeoplasmTumors] Cancer/ Neoplasm/ Tumorslipomassquamous cell carcinomamelanomaSarcoidsCutaneous lymphosarcomaBasal cell tumors/carcinomasMast cell tumorsSebaceous Gland adenomasGranulosa theca cell tumor[/group][cf7mls_step cf7mls_step-5 "BACK" "NEXT" "Diagnostics"] Attachments Upload three pictures of your horse: left side, right side, face/front NOTE: Photos should be in JPG or PNG format and each photo should not exceed 2MB in size[mfile photoUpload limit:10000000 min-file:1 max-file:3 id:photoUpload]Submit[cf7mls_step cf7mls_step-6 "Back" "Attachments"]Ask a Question Name Email Address Question Submit
