Prepurchase Examination Request Form

Subject

Purchaser's Info

Purchaser's Name

Address

City/State/Zip

Telephone #

Purchaser's Agent

Telephone #

Horse Info

Name of horse being examined

Intended use of horse

Age

Breed

Sex

Color

Seller's Info

Seller's Name

Address

City/State/Zip

Telephone #

Seller's Agent

Telephone #

Exam Info

The basic prepurchase exam consists of a physical exam which includes examination of the eyes, heart and lungs; hoof tester exam; moving exam; and flexions. The following services are available, but are not included in the basic exam:

Ultrasound Exam Tendons Suspensories Reproductive Tract

Endoscopic Exam Airways

Blood Work CBC/Chemistry Drug Screen Coggins

Additional examination to be left to the discretion of the examiner

Other requests

Veterinarian's Name

Date of Appointment

Prepurchase Examination Request Form

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