Equine Lameness Exam Report Form
Record a horse lameness evaluation with structured exam findings, history, and recommendations.
Patient & Owner Information
Horse Name
*
Horse Age
Breed
Sex
Please Select
Mare
Stallion
Gelding
Filly
Colt
Other
Owner Name
*
First Name
Last Name
Owner Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Owner Email
example@example.com
Exam Context
Exam Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Referring Veterinarian
Clinic / Location
Reason for Visit / Presenting Complaint
*
Physical/Gait Assessment
Affected Limb(s)
*
Left Forelimb
Right Forelimb
Left Hindlimb
Right Hindlimb
Multiple Limbs
Other
Lameness Severity / Grade
*
Mild
1
2
3
4
5
6
7
8
9
Severe
10
1 is Mild, 10 is Severe
Gait Description and Exam Observations
Diagnostics & Report Summary
Diagnostic Block / Imaging Notes
Assessment, Treatment & Recommendations Summary
Submit Report
Should be Empty: