Owner's Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Horse's Name *

First Name

Last Name

Sex

Mare

Gelding

Stallion

Acknowledgement *

I acknowledge that animal chiropractic (musculoskeletal manipulation) as defined by the California Veterinary Medicine Practice Act (Section 2038) is considered to be an alternative (non-standard) veterinary therapy

I'm the owner and agree with T&C

I'm an authorized representative and agree with T&C