Intake record

Horse health
& Coggins record

One per horse at intake Bring your Coggins paperwork Keeps your horse safe & the herd healthy

Note

Please bring or email a copy of your horse's most recent negative Coggins (EIA) test and vaccination records. This form captures the essentials so we can care for your horse correctly from the first day — it doesn't replace your vet's records.

Owner & horse

Owner name *

Phone *

Email *

Horse's name *

Breed

Age

Sex

Color & markings

Microchip / reg. #

Coggins (EIA) test

Date of last negative Coggins *

Accession / test #

Testing lab / vet

Vaccinations & deworming

Most recent dates. "Current" is fine if you're not sure of the exact day.

Tetanus / EWT

Rabies

West Nile

Flu / Rhino

Strangles (if given)

Last deworming (date & product)

Farrier & feeding

Shod or barefoot?

Shoeing / trim cycle

Feed program *

Supplements & how to give them

Conditions, meds & behavior

Medical conditions or allergies *

Daily or as-needed medications

Turnout & behavior notes

Confirm & sign

Typing your name and submitting counts as your electronic signature.

I confirm the information above is accurate to the best of my knowledge and that my horse's negative Coggins and vaccinations are current. I'll provide supporting paperwork and update Gracewood Acres if anything changes.

This information is accurate and my horse's Coggins & vaccinations are current.

Signed by (type full legal name) *

Date *

Signature

Sign with your finger or mouse

★ Goes straight to Gracewood Acres and is filed automatically. Save your own copy on the next screen.

Saved & sent

Got it — thank you.

Your horse's health record is with Gracewood Acres and filed for safekeeping. Don't forget to send over the Coggins paperwork. Save a copy for your records.

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Horse health& Coggins record