Welcome to Great Bay Equine! We ask that all new clients and clients with new horses fill out this form. Please fill out the information below, and call or e-mail if you have any questions.

PLEASE NOTE:

Filling out this form alone does NOT qualify you/your horse as an “active current client”. To become an active current client, you must set up an initial wellness and/or routine care visit and have an active credit card on file with us. Once we have seen your animal for a wellness exam and/or routine care visit, you will then be considered a client of GBE.

Owner Name

First Name

Last Name

Mailing Address

City

State

Zip Code

Primary Phone Type

Primary Phone Number

Additional Phone Number(s)

Please list any other important contacts and the relation to you/your horse(s) as well as their phone numbers

E-mail Address

Billing Address (if different)

Horse's Name

Horse's Registered or Show Name

Breed

Age

Registered known Date of Birth OR Estimated Age

Sex

Color

Do you currently have a primary care veterinarian for your horse(s)?

If so, please list your horse(s) current veterinarians below:

Discipline/Use

Allergies

Medical Conditions

Please List All Vaccines with Dates

If applicable, please email medical records to info@greatbayequine.com

Is Your Horse up-to-date on Coggins?

If Yes* to the Above, please select date of last Coggins:

Please email a copy of your horse's Coggins to info@greatbayequine.com

YYYY

Microchip Information (if applicable)

Number and location

Stabling Location Name

Stable/Farm Address

Stable/Farm City

Stable/Farm State

Stable/Farm Zip Code

Stable/Farm Phone Number

Trainer Name

Trainer Phone Number

Trainer E-mail Address

Farrier Name

Farrier Phone Number

Farrier E-mail Address

Is your horse insured?

If so, please provide the insurance carrier contact information and policy number in case of an emergency.

Please let us know if there is anything else you'd like us to know about you or your horse.

DISCLAIMER REMINDER

Filling out this form alone does NOT qualify you/your horse as an “active current client” with GBE. To become an active current client, you must set up an initial wellness and/or routine care visit and have an active credit card on file with us to qualify as an active GBE client.

Thank you for your interest in becoming a client of GBE!

**DISCLAIMER REMINDER**

DISCLAIMER REMINDER