Name

First Name

Last Name

What is your horses name?

How old is your horse?

What breed is your horse?

Has your horse previously been diagnosed with gastric ulceration by a Veterinarian or other professional?

Has your horse ever been gastroscoped?

This is where a camera is placed down into their stomach to check for ulcers

If your horse has been gastroscoped, what grade was the ulceration if known?

Refer to the image below for full description of grades

Does your horse display any of the following?

Please select all those that apply to your horse

Poor appetite/failure to consume a meal

Diarrhoea and/or history of diarrhoea

Coat dullness

Sudden attitude change

Decrease in performance and/or reluctance to train or move forward from the leg

Poor body condition/weight loss

Colic

Has your horse been treated previously or are they currently being treated for gastric ulcers?

If they have been or are currently being treated please describe which products were/are being used:

Please describe your horses daily feeding regime in as much detail as possible below:

Include weights of feeds if you know these

Describe your horses current work level

What is the maximum amount of time your horse spends on a float/truck regularly?

Regularly means at least travelling this distance at least once a month

Does your horse always have access to forage

This may be pasture (grass) in the paddock, hay or other forage sources

Does your horse have access to forage whilst travelling?

Is there any other information you think could be relevant to your horse having ulcers or are there other concerns you have?

Gastric Ulcers evaluation