Lameness Call Form Date:Phone Number(s):Client:Patient Name:Breed:Age:Sex:Verify Location:onset or when it began:forelimb(s) or hindlimb(s)? 1 Or both weight bearing?YesNoIf no, put in emergency call.severity of lameness: Mild Moderate Severe Varying swelling?YesNois there any heat?YesNowound present?YesNoLocation:Description:treatment given so farCan you trailer in to the clinic?YesNoAdditional History/CommentsNOTE: If your horse appears to be painful on both front feet or all four feet, reluctant to walk, walks stiffly “like on eggshells” with or without weight shifted back onto hind legs, presume laminitis and consider this an emergency until proven otherwise. Follow the instructions given in Emergencies-General Information and First Aid Treatment Notes and contact our office immediately by phone 570-727-2868.Signature*
