Pre-Purchase Seller "*" indicates required fields Pre-Purchase SellerSeller Name*Seller Phone Number*Buyer Name*Buyer Phone Number*Horse InformationBarn NameHorse Registered Name*Breed*Age*Sex*MareGeldingStallionDuration of Ownership*Current use of Horse*Has this horse been in training in the last month?* Yes No How many days per week?Date of Last Competition MM slash DD slash YYYY Medical HistoryHas the horse been examined or treated by a veterinarian in the last 6 months?* Yes No DVM nameReasonHas the horse had any joint injections in the last 6 months?* Yes No Date MM slash DD slash YYYY JointsPrevious X-rays or Ultrasound?* Yes No Date MM slash DD slash YYYY AreasAny previous Surgery?* Yes No Date MM slash DD slash YYYY ReasonAny previous injury, illness or colic?* Yes No List all within last yearHas the horse ever exhibited neurological signs?* Yes No If yes, ExplainHas this horse had any exposure to infectious disease in the past 6 months?* Yes No If yes, ExplainDoes this horse have any vices or shipping problems?* Yes No If yes, ExplainHas this horse been vaccinated or dewormed this year? Provide dates below.* Yes No Flu/RhinoWest NileEWTOtherLast Deworming product & DateNegative Coggins (EIA) DateOther lab results in last 6 monthsDoes this horse receive any medication before or after competition?* Yes No List medications and reasonHas this horse received any medication in the last month?* Yes No List medications and reasonTo the best of my knowledge the above statements are correct and I grant permission to conduct the examination as required, including any test(s) that the Veterinarian considers necessary. I also accept any risk to the horse during the course of the examination.* I agree Signature*Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
