Sussex Equine Hospital Admission Form Fields with "*" character are required to complete the form Which procedure is your horse being admitted for?* Is your horse up to date with Flu and Tetanus vaccines?*YesNo May we clip your horse if necessary?*YesNo Is your horse up to date with worming?*YesNo Does your horse have any allergies?*YesNo If so, please specify: Is your horse shod currently?*(Please be aware these need to be removed for surgery and MRI)YesNo Does your horse have any unhealed injuries?*YesNo If so, please specify: Does your horse have any habits?*YesNo If so, please specify: Does your horse have any known heart problems?*YesNo If so, please specify: Does your horse have any respiratory problems?*YesNo If so, please specify: Does your horse have any history of tying up?*YesNo Is your horse signed out of the food chain in the passport?*YesNoUnknown Any other history or illness? Any special precautions? Your horse may be lunged for a lameness assessment or a bone scan, how does your horse behave to be lunged?* Is your horse on any current medication?*YesNo If so, please specify: In the last 30 days has your horse had symptoms of, or contact with any other horses with, infectious diseases such as Flu, Ringworm or Diarrhoea?*YesNo If so, please specify: If your horse is insured, please provide the below information (if not already provided). To be completed on admission. Have you left your passport with us?YesNo Headcollar/ Leadrope:YesNo Rugs:YesNo Tack:YesNo Client to complete on discharge Name and signature of collector Did you receive your horses passport back?YesNo Discharged by: