EQUINE CARE, MEDICAL AND EMERGENCY TREATMENT INFORMATION

by Lanier Cordell and the Lousiana Horseman's Guide

Horse's Name:

Age: Color: Gender:

Markings:

Behavior Traits or Vices:

Turn Out Preferences:

Allergies:

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Medications or supplements presently beign administered (indicate dosage, frequency and method of delivery ie: in feed, by mouth, injection in muscle, injection in vein.)

MEDICATIONS DOSAGE FREQUENCY METHOD

1.

2.

3.

4.

5.

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Owner' Name:

Owner's Address:

Home Phone: Office Phone:

Cell Phone: Emergency Number:

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Please indicate your primary and emergency care Veterinarians below.

Name of Primary Veterinarian:

Office Phone: Emergency Phone:

If not available (Second Veterinarian):

Name of Secondary Veterinarian:

Office Phone: Emergency Phone:

If not available (Third Veterinarian):

Name of Secondary Veterinarian:

Office Phone: Emergency Phone:

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Do you have mortality insurance on this horse: ___ Yes ___ No

Name of Insurance Company:

Emergency Contact Name: Title:

Phone Numbers:

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Farrier's Name:

Farrier's Phone Number:

Farrier's Emergency Phone Number:

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In an emergency every attempt will be made to notify the owner first. If we are not able to reach you, we will first attempt to contact a veterinarian from the list you have provided. If we are not able to reach any of the veterinarians from your list, we will contact a veterinarian of our own choosing. Please indicate the maximum amount you are willing to authorize us to spend on your behalf for emergency medical treatment.

I, ________________________________ authorize ____________________ (the facility providing emergency shelter for my horse) to spend up to $___________ on emergency medical treatment for the above listed horse. I understand that I am responsible to pay the necessary veterinary and/or veterinary employees or agents from any responsibility in the payment of the debt incurred on my behalf.

FOR LOUISIANA OWNERS: The cost of returning these animals after the emergency will be at the owner(s)’ (agent’s) expense. If an animal is not claimed within thirty (30) days after the animal owner(s) agent is given notice in accordance with La. R.S. 3:2453 to retrieve the animal(s) then the animal(s) will be deemed abandoned and disposed of in accordance with the Louisiana Abandoned Animal Act (R.S. 3:2551.2451)

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Owner's/Parent's Signature Date

(MUST BE OVER 18 YEARS OF AGE)