Equine Magnesium Questionnaire

Section 1: General Information My horse has a history of medical problems or laminitis or colic/ulcers Yes No

Section 1: General Information Has had surgery in his lifetime Yes No

Section 1: General Information Has been treated for ulcers Yes No

Section 1: General Information Has been diagnosed Cushings or Insulin Resistance Yes No

Section 1: General Information Has a history of abuse or neglect Yes No

Section 1: General Information Was over-trained or over-ridden as a youngster Yes No

Section 1: General Information Was competed on extensively from ages 3 to 6 Yes No

Section 1: General Information Works 4 days or more per week and is getting worse with time, not better Yes No

Section 1: General Information My horse is being shown Never Soon Formerly Currently

Section 1: General Information Bites, kicks; acts aggressively Never Sometimes Frequently You Never Know Day to Day

Section 1: General Information Grinds his teeth Never Sometimes Frequently Always

Section 1: General Information Is high strung or nervous Never Sometimes Frequently Always

Section 1: General Information Spooks Never Sometimes For No Reason Cannot Settle Down Afterwards

Section 1: General Information Displays repetitive motion behavior: like stall walking, head bobbing, weaving, cribbing or head shaking Never Sometimes Frequently Always

Section 1: General Information Displays repetitive motion behavior Never Sometimes Frequently Always

Section 2: At Home Gets daily vitamin supplement Never Sometimes Frequently Always

Section 2: At Home Gets daily joint supplement Never Sometimes Frequently Always

Section 2: At Home Gets slippery elm supplement Never Sometimes Frequently Always

Section 2: At Home Gets sweet feed, more than 1 pound a day Never Sometimes Frequently Always

Section 2: At Home Grumpy or anti-social Never Sometimes Frequently Always

Section 2: At Home Runs/paces fence in pasture Never Sometimes Frequently Always

Section 3: Away From Home Is good at home and comes undone at shows Never Sometimes Frequently Always

Section 3: Away From Home Reluctant (or refuses) to go through gates Never Sometimes Frequently Always

Section 3: Away From Home Refuses to go forward (balky) to go through gates Never Sometimes Frequently Always

Section 4: In the Crossties Dislikes being bathed Never Sometimes Frequently Always

Section 4: In the Crossties Winces from stiff brush or a firm curry Never Sometimes Frequently Always

Section 4: In the Crossties Pins ears during saddling and girthing Never Sometimes Frequently Always

Section 4: In the Crossties Trembles (commonly in knees and flanks) Never Sometimes Frequently Always

Section 4: In the Crossties Skin flinches or twitches when touched Never Sometimes Frequently Always

Section 4: In the Crossties Dislikes chiro/body work or needs more than normal Never Sometimes Frequently Always

Section 4: In the Crossties Has trouble holding hind legs for shoer Never Sometimes Frequently Always

Section 4: In the Crossties Is hard-muscled or tense, even in the stall Never Sometimes Frequently Always

Section 4: In the Crossties Paws, frets or becomes defensive when tied Never Sometimes Frequently Always

Section 5: In Training Is consistently inconsistent, in attitude and Section 5: in training Never Sometimes Frequently Always

Section 5: In Training Has been described as lacking focus (ADD) Never Sometimes Frequently Always

Section 5: In Training Feels stiff or hollow moving Never Sometimes Frequently Always

Section 5: In Training Over reacts to cues and aids Never Sometimes Frequently Always

Section 5: In Training Requires long, slow warm-up Never Sometimes Frequently Always

Section 5: In Training Difficulty with transitions, cantering, collection Never Sometimes Frequently Always

Section 5: In Training Chomps on the bit constantly Never Sometimes Frequently Always

Section 5: In Training Unexplained bucking or bolting episodes Never Sometimes Frequently Always

Section 5: In Training Has a definite time window that he can tolerate work - and then acts out Never Sometimes Frequently Always

Section 5: In Training Had an injury and was competed while in pain Never Somewhat Extensively Excessively

Section 5: In Training Is any of this very NEW behavior for an otherwise well-trained horse? Yes No