Adequan Registration

We'd like to hear about your experience with joint disease and Adequan® i.m. (POLYSULFATED GLYCOSAMINOGLYCAN). Please tell us why you use Adequan® i.m. and how well it has worked for your horse(s). Also let us know if you need more information on equine joint health.

Name:

Business Name:

Address:

City:

State:

Zip:

Phone:

Email Address:

Please send me a DVD of this educational program

Number of copies

I use Adequan® because:

What discipline(s) are you primarily involved with? (check all that apply)

What breed of horse do you own?

I'd like to share my experience with Adequan®:

Please submit a photo of your horse(s) in action

Name of the horse in the photo

Name of photographer/studio

Photographer address/email

Photographer's phone number

I give permission for Luitpold Animal Health/Adequan® to use my statements/photographs as I submitted on "Experiences With Adequan" web site for use in promotional materials.

How many horses do you own?

How many of your horses have suffered from degenerative joint disease?

Would you use educational information to better understand joint injuries?

Yes

No

If yes, what formats work best?

meeting

printed brochure

video presentation

on-line/web-based educational presentation

Other (please explain below)

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Click the submit button to save your updated information. Thank you for sharing your experience.