Pre-Purchase Buyer Request Name of Horse*Requested Date of Exam* MM slash DD slash YYYY Intended Use*Age of Horse*Buyer's Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please check all the services that you would like to have performed at the time of the exam:Clinical Examination Clinical Examination: This examination includes a general health exam evaluating the eyes, heart, lungs, gastrointestinal and musculoskeletal systems. A dynamic evaluation of the horse’s gait will be done to assess for lameness or other abnormalities. Radiographs: (Please check only items wanted) Standard Screening Radiographs: This package includes 18 radiographs at a discounted rate. Views in this package usually include 4 views of each front foot, laterals of each fetlock, and 3 views of each hock. Comprehensive Screening Radiographs: This package includes 32 radiographs. Views in this package usually include 4 views of each front foot, 4 views of each front fetlock, 2 views of each hind fetlock, 4 views of each hock and 2 views of each stifle. Only areas of concern: When areas of concern are identified on clinical exam and x-rayed, these will be charged per radiographic view. Neck Radiographs Back Radiographs (Dorsal Spinous Processes) Other (Please Specify) Please SpecifyBlood Tests Drug Screen – For detection of NSAIDs, tranquilizers, muscle relaxants, etc. (Results take 7-10 Business days) CBC & Chemistry – Helps to assess organ health and establish a baseline for the horse. (Results in 1-2 Business Days) Coggins – Tests for Equine Infectious Anemia (EIA) Required for shows and/or export (Results in 3-5 Business Days) Other Services Endoscopy (Please specify below) Insurance Form Completion Export Form to United States Completion Endoscopy – Please SpecifyWho to contact with findings* First Last Phone*Date* MM slash DD slash YYYY Signature*EmailThis field is for validation purposes and should be left unchanged.
