Equine Myofascial Release Session Intake Form
Please complete this form to help us prepare for your horse's myofascial release session. Accurate information ensures a safe and effective session.
Owner/Client Full Name
*
First Name
Last Name
Owner/Client Email Address
*
example@example.com
Owner/Client Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone Call
Text Message
Horse Name
*
Horse Age
*
Horse Breed
*
Please Select
Thoroughbred
Quarter Horse
Warmblood
Arabian
Pony
Draft
Other
Horse Sex
*
Mare
Gelding
Stallion
Primary Reason for Session
*
Current Concerns or Symptoms
*
Relevant Medical or Bodywork History
Recent Injuries or Surgeries (within the past year)
Current Medications or Supplements
Current Workload or Activity Level
Please Select
Retired
Light work
Moderate work
Heavy work
Competition
Other
Behavior or Training Notes
Handling Sensitivities (e.g., areas to avoid, behavioral triggers)
Preferred Session Date/Time or Availability
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Special Instructions or Additional Notes
Submit Intake Form
Should be Empty: