REGISTER

REGISTRATION FORM

First Name *

Last Name *

Phone *

Email *

Insurance Policy Details

Yard Address

Horse Name *

Horse Breed

Horse Height

Existing Conditions *

Reason For Visit

Do you need to add a second horse? *

Horse Name - 2

Horse Breed - 2

Horse Height - 2

Existing Conditions - Horse 2

Reason for visit - Horse 2

Do you need to add a third horse? *

Horse Name - 3

Horse Breed - Horse 3

Horse Height - Horse 3

Existing Conditions - Horse 3

Reason for visit - Horse 3

Do you need to add a fourth horse?

Horse Name 4 *

Horse Breed - 4

Existing Conditions - Horse 4

Reason for visit - Horse 4

T&Cs *

All treatment is payable in advance. If you are wishing to make a claim from your insurance company we can support you in this, but require treatment to be paid in full upfront. We will always obtain your consent prior to carrying out any treatment. You give us permission to liaise with other professionals, such as your vet, physiotherapist etc regarding your horse and their treatments with us. I hereby confirm that I am the owner of the above named horse or otherwise authorised to register the horse and to arrange and consent to treatment and I acknowledge that I shall be liable for all costs and fees incurred.

Signature *

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+44 (0) 7545 590 365

info@rhodenrehab.com

Mon - Sat 8:00-17:00

Rhoden Stables, Lucks Lane, Paddock Wood TN12 6PA

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