The Piedmont Equine Practice was founded by Dr. John Nolan in April of 1996. Over the next several years Drs. Davis, Bowman, Anikis and Diehl joined the practice. As a group of peers, and with Drs. Nolan, Davis and Anikis being classmates in veterinary school, a culture of collaboration and mutual mentorship developed as they worked together. The first office was in the living room of Dr. Nolan’s rental house. The second office was in Marshall, Virginia, in an 800-square foot second-floor space. Over the span of a few years, as staff and pharmacy expanded, and with the addition of our first associate Dr. Alexis Theiss, this space went from spacious to full to mosh pit; we needed more room. At the same time, we wanted to offer more involved and complicated procedures than could be performed at a client’s barn. We bought the old Fauquier 4-H fairgrounds and, after a number of years of fitful progress, opened our clinic facility and barn in November of 2006. The clinic worked well for the intended use, expanding our lameness and elective surgery caseload, but we saw an additional potential opportunity: doing critical care emergencies. This started slowly and then expanded rapidly after the 2011 hire of surgical and critical care specialist Dr. Sarah Dukti, followed later by surgical specialist Dr. Courtney Bolam. In 2015 we again needed more space and added an addition to the barn, new isolation stalls, a larger radiology suite, additional office space and living quarters for visiting veterinary students. The Piedmont Equine Clinic now has a busy critical care, lameness and ambulatory caseload and has grown to 16 veterinarians.