Wellness Submission Form

2026 Wellness Program Enrollment
Hunt Country Equine offers a 'Wellness Program' that will allow you to give your horse the care it needs while saving money. The basic plan is broken down with some optional services below so that you can customize your program to fit both your horse and your budget. To be eligible for the Wellness Program discount you must complete the authorization form for each horse you wish to enroll and payment is due at enrollment. Enrollment deadline for the 2026 Wellness Program is December 31st. Plans not enrolled and paid for by December 31st 2025 will not be eligible for discount.
*The wellness program is non-refundable but is transferrable*

 The following services are required as part of the 2026 Wellness Program, unless the item is specifically contraindicated to the well-being of your horse by your veterinarian

Yearly Coggins Test $56.00
Spring Complete Physical Exam $95.00
 (Physical exams allow us to identify problems early that may not be evident to even the most attentive owner such as subtle vision problems, heart conditions, and more.)
Spring Fecal Exam $32.00
 (Additional fecals may be required based on each individual horse's results and treatment requirements. These cannot be charged in advance but if required will be charged at the same 15% discount for those who are enrolled in the Wellness Program.)
Spring EWT/WN  $86.00
 (We choose the vaccines that are proven both by research and clinical experience to provide good immunity and are the safest for your horse.)
Spring Farm Call* $60.00 (Minimum $60.00 depending on location)
Yearly Rabies Vaccine $32.00
Fall Complete Physical Exam $95.00
Fall EWT/WN $86.00
Fall Fecal Exam $32.00
Fall Farm Call* $60.00 (Minimum $60.00 depending on location)

Actual Cost of Services $634.00
Cost after 15% Wellness Discount $538.90
Cost per additional horse $436.90

 *Farm calls are billed per client, not per horse and will be adjusted based on mileage, $60 is the minimum.


Elective Services
The following services are also eligible for a 15% discount if elected during the sign up process. Please put your a yes or no next to the additional services you would like to sign up for below. 
                                                                          Actual Cost                   Discount price              Yes or No
Spring/Fall Flu-Rhino Combo                                  $124.00                         $105.40                       ________
Potomac Horse Fever                                              $56.00                            $47.60                       ________
Sheath Clean w/sedate                                           $95.00                             $80.75                       ________
Dental with sheath clean                                        $295.00                         $250.75                        ________
Yearly Dental Exam/ Float                                       $250.00                         $212.50                        ________
Additional Farm Call for Dental*                             $60.00                             $51.00                        ________
CBC & Chemistry Screening                                   $265.00                         $225.25                        ________
ACTH (Baseline cushings/PPID)                              $160.00                         $136.00                        ________
Insulin (EMS)                                                         $92.00                             $78.20                        ________
T4 (Thyroid function)                                              $80.00                            $68.00                        ________


 *Farm calls will be adjusted based on mileage, $60 is the minimum.


Horse's Name  _______________________________________________________________

Age __________________________________________________________________________

Breed_________________________________________________________________________

Owner's Name_________________________________________________________________

Program is transferable but not refundable due to voluntary withdrawal.

Signature______________________________________________________________

Date___________________________________________________________________