New Client Intake Form

Please complete the following intake form to the best of your ability and knowledge for the horse receiving services. If you have multiple horses that will be receiving services, please complete a new form for each horse.

If you have any questions, please reach out.

Phone:

705-305-0179

Email:

elevatedequinemassage@gmail.com

Social Media

Horse Information

Owner's Name (First & Last)

Phone

Horse's Name and Breed

Horse Age

Describe the horse's discipline(s) this horse performs, the # of times per week the horse is ridden and horse's competitive season if appicable

Is your horse in a regular massage/chiro or other bodywork program? Please provide details.

I AM ALLOWING ELEVATED EQUINE MASSAGE AND ALL PERSONS CORRELATED TO THE COMPANY TO ASSESS, TREAT AND CUSTOMIZE A PROGRAM FOR MY HORSE. I AGREE TO HOLD THEM HARMLESS FOR ALL INCIDENTS THAT MAY OCCUR DURING THE TIME ELEVATED EQUINE MASSAGE IS PRESENT, OR DURING THE TIME I AM CARRYING OUT THE ASSIGNED PROGRAM.

I AGREE TO SEEK VETERINARIAN ADVICE FOR ANY APPLICABLE CIRCUMSTANCES OR SCENARIOS, AND UNDERSTAND THAT ELEVATED EQUINE MASSAGE'S ADVICE AND SERVICES DO NOT REPLACE VETERINARY CARE AND ARE NOT CONFIRMED DIAGNOSES OF ANY INJURY OR CONDITIONS

I AGREE TO ALLOW ELEVATED EQUINE MASSAGE TO TAKE PICTURES AND VIDEOS OF MY HORSE AS A METHOD OF MAINTAINING RECORDS BUT I ALSO UNDERSTAND THAT THE PICTURES AND VIDEOS MAY BE SHARED FOR PROMOTIONAL PURPOSES.

Please insert your first and last name below. By providing your name, you are indicating that you have read the above terms and conditions and agree to the waiver and form.

Thanks for submitting!