Pre Purchase Examination Form Purchaser

Please be advised that the Pre-Purchase Examination cannot be conducted unless both Purchaser and Seller Forms are completed in full prior to scheduled appointment

Today's Date(Required)

Registered Name of Horse(Required)

Name of Purchaser(Required)

GENERAL INFORMATION TO PURCHASER: An examination for pre-purchase by a veterinarian is a general physical examination. The examination is conducted by a veterinarian in a systematic manner to evaluate the horse and to look for signs of disease, injury, physical abnormalities, or significant gait abnormalities. If special tests are requested by the purchaser, permission to do the tests must be given by the present owner or agent. It is the responsibility of the owner or agent to present the horse to the purchaser and examining veterinarian with a complete and accurate history of the horse’s past performance, past behavioral characteristics, and past medical history including all medications.

Buyer/Agent Name(Required)

Buyer/Agent Phone(Required)

Buyer/Agent Email(Required)

Address of Purchaser(Required)

Street Address City State ZIP Code

Examination Location(Required)

Street Address City State ZIP Code

Requested By(Required)

Buyer's Intended Use(Required)

Is the Horse to be Insured?(Required)

Who will represent you during the exam?(Required)

I will

Trainer

Barn Manager

Other

Representing Parties Name

First Last

Representing Parties Phone

Payment Policy: In order to keep costs low for all clients, please note that payment is due at the time of service. We accept cash, check, debit , and all major credit cards. (Credit cards subject to 3% processing fee) Please be prepared to pay your balance in full before departure. Thanks! ~The CEC Team

Acknowledgement

I acknowledge that the information in this form is true and accurate.

Signature(Required)

Phone

This field is for validation purposes and should be left unchanged.

Pre Purchase Examination Form Purchaser

Please be advised that the Pre-Purchase Examination cannot be conducted unless both Purchaser and Seller Forms are completed in full prior to scheduled appointment

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