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Welcome to Be Part of the Research Survey!
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1. Title:
Mr.
Mrs.
Ms.
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2. Name: Personal information will be used only as follow up, if needed. Your information will NOT be sold. Thank you!
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3. Contact Number:
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4. Email address:
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5. Country:
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6. State:
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7. Horse's Name: (one horse per survey, please). If you have more than one horse with this condition, please complete a separate survey for each.
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8. Breed:
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9. Sex of Horse:
Mare
Stallion
Gelding
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10. Age of Horse:
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11. Identify area of swelling (check all that apply):
Front left leg
Front right leg
Rear left leg
Rear right leg
Other
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12. How long has the horse had this condition?
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13. Cause, if known:
Lymphangitis
Chronic Progressive Lymphedema-CPL
Cellulitis
Scratches
Injury
Surgery
Infection
Unknown
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14. Where is the horse kept?
Home
A barn facility
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15. Approximate cost of acute phase (initial onset of the swelling). Include vet visits, medication, etc.
$200 - $399
$400 - $699
$700 - $999
$1000
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16. Approximate cost of chronic phase (repeat vet visits):
$200 - $399
$400 - $699
$700 - $999
$1000
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17. When is the condition most noticeable?
Stalled only
All the time
Intermittent
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18. How long does swelling last?
A few days
Weeks
Never goes away
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19. What time of the year is the most problematic?
Spring
Summer
Late Fall
Winter
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20. Has your horse been euthanized?
Yes
No
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21. Did the horse experience any of the following BEFORE being diagnosed with lymphedema or CPL: abscesses, laminitis/founder, or colic? (If yes, check all that apply below in question 22).
Yes
No
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22. Select all that apply:
Abscesses
Laminitis/founder
Colic
Other
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23. AFTER the horse was diagnosed with lymphedema or CPL, has it experienced any of the following: abscesses, laminitis/founder, or colic? (If yes, check all that apply below in question 24).
Yes
No
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24. Select all that apply:
Abscesses
Laminitis/founder
Colic
Other
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25. If the horse had scratches, cellulitis, or any other condition prior to being diagnosed, please describe the timeframe. E.g. Diagnosed with scratches in left hind leg 6 months ago:
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26. Does the infected leg have a "white stocking?"
Yes
No
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27. What else do you want us to know?
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28. Would you like more information on our lymphedema training package?
Yes
No
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