Thank you for choosing Herbsmith Custom Formulations for your horse. A one-time formula consultation fee of $45 is charged for determining the best formula for your horse (whether a custom-designed formula or Classic Formula). This fee is in addition to the regular container prices. When you submit this form, you will be automatically taken to the Herbsmith store to process the $45 fee.
 
Owner's Name:
Address:
City:
State:
Zip:
Day Phone Number:
Evening Phone Number:
Email Address:
Horse's Name:
Stallion
Mare		 Gelding
Pregnant
If pregnant, how many months?
Age:
Breed:
What is the primary use of the horse? (Example: showing, racing, breeding, pasture mate, pet, etc.) 
Is the horse ridden, driven, both, other?
What is the primary complaint?
What is the horse's current and past medical history?
How is the horse's behavior when:
  Being ridden?
  Handled from the ground?
  Being lunged?
  With other horses?
Is the horse calm or hyperactive? Does he/she stand quiet or move around frequently? Other?
Has the "normal" temperament changed recently?
(Example: when  it's being tacked, ridden, etc.)  How?
Digestive System:
Is there a history of colic and/or diarrhea?
Feeding:
How quickly does he/she eat?
Amount of grain fed?
Hay?
Other?
Have these amounts recently changed? Yes No
If so, how?
 
Water Consumption:
Approximate amount of water consumed daily? 
(Example: excessive, minimal, etc.)
Has this amount recently changed? Yes  No
If yes, how?
Quality of Manure: (dry, watery, normal apples, soft apples, color, odor, etc.)
Urinary: Quality (dark in color, foul smelling, etc.)
What is the "normal" volume or urination?
Has this amount recently changed? Yes No
If  yes, how?
Respiratory System:
History of coughing:when,where?
How long does the cough last?
Does anything make it worse?
What makes it better?
Environment:
What type of environment does the horse live in? (Example: outside, .
stalled with turn out, training facility.
What type of bedding is used?
Muskuloskeletal:
Has there been a history of "tying up" or any muscle cramping?
  No   Yes   When?
Lameness History:
Is the horse lame? YesNo
If so, in one or multiple joints? One Multiple
Which joints?
How long has he/she been lame?
Could the lameness be due to any type of trauma? Yes No
What makes the lameness worse?
What makes the lameness better?
Movement:
How does the horse move over all? (Fast, slow, etc.)
Has the movement in different gaits or transitions recently changed?
No Yes    If so, how? 
Any history of tendon problems?   Yes  No
How is the hair coat quality?
Any problems with shedding out seasonal coats?
How is the quality of the mane and tail?
Any other information we should know?

When you click Send, you will be automatically redirected to the Herbsmith store to process the $45 formula consultation fee.