Groundwork Equine

Multi-Horse Intake Form

A starting point for your horses' nutrition journey.

Prepared for

Owner & Operation

Barn, farm, or owner with two or more horses.

How to use this form

Start with the Horse Roster. The horses listed as Horse 1, Horse 2, Horse 3, and so on carry through every section that follows. Complete each section in order. If something does not apply, leave it blank.

Each nutrition review is prepared with the individual horse in mind. This form allows you to share information about multiple horses efficiently while still capturing what makes each horse specific. Groundwork Equine will consider each horse's current nutrition, health history, body condition, workload, environment, management routine, concerns, and goals.

Section 01

Owner Contact

Owner / Lessee NameFarm or Operation NamePhone NumberEmail AddressMailing AddressPreferred Method of Contact

Section 02

Primary Veterinarian

Veterinary ClinicVeterinarian NamePhone or EmailCity & Province

Additional vet notes (if any horse uses a different veterinarian)

Section 03

Primary Farrier

Farrier NamePhone or EmailCity & Province

Additional farrier notes (if any horse uses a different farrier)

Section 04

Properties & Locations

Use Property A, B, and C for the primary locations where your horses live. If you have more locations, list them in the additional notes field below.

Property A

Farm or Barn NameStreet AddressCity, Province & Postal CodeNumber of Horses Kept HereTurnout TypePasture AccessStall or Shelter Access

Notes

Property B

Farm or Barn NameStreet AddressCity, Province & Postal CodeNumber of Horses Kept HereTurnout TypePasture AccessStall or Shelter Access

Notes

Property C

Farm or Barn NameStreet AddressCity, Province & Postal CodeNumber of Horses Kept HereTurnout TypePasture AccessStall or Shelter Access

Notes

Additional property notes (use letters D, E, etc. if more than three locations are needed)

Section 05

Horse Roster

List up to fifteen horses. The Horse # assigned here carries through every section that follows.

Horse #	Name	Breed	Age	Sex	Height	Approx. Weight	Discipline	Days/Wk	Property	Diff. Vet/Farrier?	Notes
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 06

Current Diagnoses

Check any diagnosis that currently applies to each horse.

Horse #	Name	EMS	Insulin Dysreg.	PPID / Cushing's	PSSM1	PSSM2	RER / Tying Up	HYPP	Heaves / Asthma	IBD / Diarrhea	Obesity	Underweight	Muscle Wasting	Poor Topline	Allergies	Other
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 07

Past Conditions

If a horse has experienced any of these, briefly describe the year, severity, treatment, and outcome in the cell.

Horse #	Name	Colic	Laminitis / Founder	Gastric Ulcers	Hindgut Ulcers	Major Injury / Surgery	Other Relevant History
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 08

Body Condition Scoring

Score each area from 1 to 9 where 5 is moderate. Use the notes column for observations, asymmetries, or areas you are unsure how to score.

Henneke Body Condition Scale

1, Poor
2, Very Thin
3, Thin
4, Moderately Thin
5, Moderate
6, Moderately Fleshy
7, Fleshy
8, Fat
9, Extremely Fat

Horse #	Name	Neck & Crest	Withers	Back & Topline	Ribs	Hindquarters	Tailhead	Notes & Observations
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 09

Feeding Goals

Check any goal that applies to each horse. Use the final column to add additional context.

Horse #	Name	Weight Gain	Weight Loss	Muscle Dev.	Digestive Support	Calming / Stress	Ulcer Mgmt.	Coat & Skin	Hoof Support	Immune / Allergy	Performance	Other Goals or Notes
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 10

Current Medications

Horse #	Name	Medication Name	Dose	Frequency	Reason for Use	Prescribed By	Notes
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 11

Current Supplements

Horse #	Name	Supplement Name	Dose	Frequency	Reason for Use	Notes
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 12

Current Feed, Hay & Forage Schedule

List grain, concentrates, mash, beet pulp, ration balancer, hay type, hay amount, pasture access, and any other feed offered. Use approximate amounts such as pounds, scoops, flakes, or cups.

Horse #	Name	AM Feed	Midday Feed	PM Feed	Late Night / Other	Hay Type	Hay Amount	Pasture Access	Salt Access	Water Access	Notes
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 13

Concerns & Observations

Note any concerns or changes you have observed in each horse.

Horse #	Name	Weight	Energy	Coat / Skin / Hooves	Digestion	Behaviour	Performance	Appetite	Recovery	Other Concerns
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Horse 14
Horse 15

Section 14

Photos & Documents

Please label each photo or file with the horse's name.

Section 15

Operation Notes / Anything Else

Tell us about your operation

Section 16

Consent & Acknowledgement

I understand this intake form is for nutrition education and consultation purposes.I understand this does not replace veterinary diagnosis or treatment.I confirm the information provided is accurate to the best of my knowledge.I understand Groundwork Equine may request additional information before completing recommendations.

Signature (Type Full Name)Date

Once submitted, Jillian will review your information and follow up with next steps by email.

Thank you

Thank you for trusting Groundwork Equine with your horses' nutrition journey. Once your intake form, photos, and supporting documents are received, Jillian will review your information and follow up with next steps.

Jillian Nielsen

Certified Equine Nutrition Advisor

jillian@groundworkequine.cagroundworkequine.ca

Rooted in science. Grounded by connection.