Horse Hospitalization Drop-Off Form

Owner/Responsible Party Information

Please list all medications and supplements the horse is currently receiving. Include dose, frequency, and last date given.
If patient is not a regular patient of Tennessee Equine Hospital, please complete this section.

Feed & Hay Handling Policy

  • Tennessee Equine Hospital is unable to accept large feed bags or large quantities of hay.
  • All owner-provided feed, grain, and supplements must by clearly labeled with the horse's name.
  • Feed and supplements must be packaged into individual, pre-measured servings. 
Grain/Hay Source (Check all that apply.)

Hay Instructions (Fill out section that applies: hospital-provided or owner-provided.)

Grain Instructions (Fill out section that applies: hospital-provided or owner-provided.)

Blanket(s), Halter/Lead Robe, Grain/Hay (type and amount), Supplements (type and amount), Medications (name and amount), etc.
Tennessee Equine Hospital may occasionally take photographs or videos of patients during hospitalizations, procedures, or treatment for education or online content purposes. No patient, owner, or identifying information will be disclosed.  
I authorize Tennessee Equine Hospital to care for the above-named horse and follow the instructions provided on this form.