Pre Purchase Examination Form Seller

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

OWNER-AGENT DECLARATION REGARDING THE HORSE TO BE PURCHASED

Seller/ Agent(Required)

First Last

Will you be present at the pre-purcahse? (Note: the pre-purchase exam cannont be completed unless you are present or reachable by phone)(Required)

Yes

No

Phone(Required)

Email(Required)

Address of Seller(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

How is this person related to you and/or horse?(Required)

Horse's Show Name(Required)

Horse's Barn Name(Required)

Sex(Required)

Mare

Stallion

Gelding

Color(Required)

Markings(Required)

Tattoo

How long have you owned/cared for this horse?(Required)

What event(s) is the horse used for?(Required)

What event(s) has the horse been used for in the past? The past 6 weeks?(Required)

At what level of competition?(Required)

Is the horse in current work?(Required)

How many times/week?(Required)

Type of exercise?(Required)

Past/Present vices/behavioral problems?(Required)

Past/Present medical problems?(Required)

Past/Present lameness problems?(Required)

Has the horse had any previous surgeries?(Required)

Known Allergies(Required)

Has the horse had any of the following conditions?

Nose bleeding

Cough

Colic

Laminitis (founder)

Lameness

Is the horse presently on medication or supplements?(Required)

Yes

No

If yes please provide the medication name, dosage, frequency, and if oral or injectable(Required)

Is your horse needle shy?(Required)

Has the horse been medicated-tranquilized in order to perform?(Required)

Type of medication used and how often?(Required)

What was the product used and date of the last de-worming?(Required)

Have any joints been treated with intra-articular therapeutic medications? If so please explain:(Required)

For what diseases has the horse been vaccinated during the past year and when?

Sleeping Sickness

Tetanus

Influenza

West Nile

Strangles Intranasal

Rhinopneumonitis

Rabies

Has the horse had routine dental care?(Required)

Date of the last float

Current Diet(Required)

When was the horse last trimmed or shod?(Required)

What is your regular schedule?(Required)

Is the horse insured?(Required)

Yes

No

Insurance Provider Contact Info

Housing(Required)

(Indoor, outdoor, etc)

Stable Address

Name of Stable Street Address City ZIP / Postal Code

Trainer Name (if applicable)

Trainer Phone (if applicable)

Farrier Name (if applicable)

Farrier Phone (if applicable)

Submit Form

Please upload any medical records, medical imaging, pictures, videos or other relevant information here

Accepted file types: jpg, gif, png, pdf, mp4, mov, Max. file size: 32 MB.

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)

Comments

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

Pre Purchase Examination Form Seller

For what diseases has the horse been vaccinated during the past year and when?

Submit Form

Contact Us

Clinic Hours of Operation