Online Survey for Equine Metabolic Syndrome


Thank you for your interest in participating in equine metabolic syndrome (EMS) research. We are currently not accepting additional horses into the study but if you would like to fill out the survey and submit your horse' s information for involvement in future EMS studies you are welcome to do so.


Contact Information

Your Name:

Phone Number:

Your e-mail:

Horse's Call (Barn) Name:

Horse's Registered Name:


Veterinarian Information

Veterinarian Name:

Clinic Name:

Clinic Address:

Clinic Phone:

Veterinarian/Clinic e-mail:


Signalment

Horse's (approximate) year of birth?

What breed is the horse?
Other:

What is the horse's gender?

Would you describe your horse as an
"easy keeper" (tends to gain weight easily)?


Laminitis

Has your horse been previously diagnosed with laminitis?

Please fill in the blank with any additional medical conditions
occurring at the time of laminitis if "yes" was selected for
the previous question?



Phenotype

Is your horse overweight?

Is your horse underweight?

Does your horse have a thick, cresty neck?

Does your horse have fat pads on its rump?

Does your horse have haircoat that sheds later
in the year?

Does your horse have thick or long curly haircoat?

Does your horse urinate more than normal?

Does your horse drink more than normal?


Previous Lab Work

Has your horse had any of the following lab work done?
Insulin Level:

Glucose Level:

Dexamethasone Suppression Test:

How many other horses are kept on the same
property as your horse?

How many other horses kept on the same property
have experienced laminitis in the past?

How many other horses on the same property are overweight
or have been diagnosed with equine metabolic syndrome?


May we contact you for more information?