Layoff Report

Horse Name/Tattoo or Microchip #: *

Horse’s Age: *

First-Time Starter (Y/N): *

Date/Track of Last Race: *

Planned Date/Track of Entry: *

Owner: *

Owner Phone:

Owner Email:

Trainer: *

Trainer Phone: *

Trainer Email: *

Primary Veterinarian: *

Primary Veterinarian Phone: *

Primary Veterinarian Email: *

Reason for Layoff: *

How long has the horse been in your care? *

(If less than 30 days) Previous Trainer:

Please skip this section if not applicable.

Previous Trainer's Phone:

Please skip this section if not applicable.

Previous Trainer's Email:

Please skip this section if not applicable.

Was surgery performed on this horse during the layoff? *

horse surgery on

If yes, provide the date, type of surgery and veterinarian: *

Do you have surgery discharge documents available?: *

Surgery Discharge Document(s) Upload *

Click or drag a file to this area to upload.

Please upload a Word document, PDF, JPG or PNG file.

Has this horse ever been treated with bisphosphonates (e.g., Tildren, Osphos)? *

Is the horse on any medication, including trainer or veterinary administrations? *

If yes, list all current medications/treatments and applicable diagnosis: *

Has the horse been treated with shockwave therapy since its last race? *

If yes, provide the veterinarian, dates and the area of the horse’s body treated for all treatments: *

Diagnostic tests (radiographs, scans, bloodwork etc.) performed since last race. Provide veterinarian, dates, details and results: *

Intra-articular joint injections performed since last race. Provide veterinarian, dates and details (body part and medication): *

Name:

Date:

Signature:

Clear Signature

150-Day Layoff Report