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Boarding Operations

Health, Vaccination & Coggins Intake Form

Horse boarding health intake form: negative Coggins, AAEP core and risk-based vaccines, CVI, deworming, and medical history, with an owner accuracy attestation.

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HEALTH, VACCINATION & COGGINS INTAKE FORM
Fill-in-the-blank template — review with an equine attorney licensed in your state before use.

This Health, Vaccination & Coggins Intake Form is completed by the horse owner ("Owner") before a horse is admitted to [FACILITY NAME] ("Facility") and becomes part of the horse's permanent file. Its purpose is to confirm the horse poses no known disease risk to the other horses at the Facility and to give the Facility the health information it needs to care for the horse. The Owner must attach the documents this form requires; a horse may be refused admission, or held in isolation, until required proof is provided.

BIOSECURITY REQUIREMENTNo horse will be unloaded into general boarding without a current negative Coggins (EIA) test on file. A horse arriving without required paperwork or showing signs of contagious illness (fever, nasal discharge, cough, diarrhea) may be refused or isolated at the Owner's expense.

1. Horse Identification

Horse Name (barn name and registered name): ______________________________

Breed: ______________________________

Age / Year of Birth: ______________________________

Sex: ______________________________

Color and Markings: ______________________________

Microchip / Tattoo / Brand Number: ______________________________

Owner Name and Phone: ______________________________

2. Negative Coggins (EIA) Test — Required

The Coggins test screens for Equine Infectious Anemia (EIA), a contagious, incurable, and often fatal blood-borne disease for which there is no vaccine. Infected horses must be permanently quarantined or euthanized, so a current negative test is the only way to protect the herd. The Owner must provide a negative Coggins test dated within the last 12 months and attach a copy to this form. (Some show and event venues require a test within 6 months; provide the most recent test available.)

Coggins Test Date: ______________________________

Laboratory / Accession Number: ______________________________

Result (must be NEGATIVE): ______________________________

Test Type (AGID or ELISA): ______________________________

☐ A copy of the negative Coggins test is attached to this form.

3. Core Vaccinations (AAEP)

The American Association of Equine Practitioners (AAEP) classifies the vaccines below as core vaccines that every horse should receive annually. Enter the date each was last administered and attach the veterinarian's vaccination record. Horses not current on core vaccines may be required to update them before or shortly after arrival, at the Owner's expense.

Eastern & Western Equine Encephalomyelitis (EEE/WEE) — date last given: ______________________________

Tetanus — date last given: ______________________________

West Nile Virus — date last given: ______________________________

Rabies — date last given: ______________________________

4. Risk-Based Vaccinations