Pre-Purchase Exam Form "*" indicates required fields URLThis field is for validation purposes and should be left unchanged.Buyer InformationName*Address*Phone Number*E-Mail* Intended Use of Horse*Seller InformationName*Address*Phone Number*Past/Current Use of Horse*Horse InformationRegistered Name*Barn Name*Age*Color/Markings*Duration of Ownership*Breed*Gender*Height/Weight*Tattoo/Brand*Medical HistoryRecent Coggins* Yes No ExplanationHistory of Colic* Yes No ExplanationHistory of Lameness* Yes No ExplanationPrevious x-rays* Yes No ExplanationHistory of Neurologic disease* Yes No ExplanationHistory of Respiratory disease* Yes No ExplanationHistory of Tie up* Yes No ExplanationHistory of pregnancy* Yes No ExplanationPrevious Surgery* Yes No ExplanationVaccine Reactions* Yes No ExplanationMedications in previous 2 months* Yes No ExplanationVices (cribbing, windsucking, weaving, biting)* Yes No ExplanationAdditional Medical HistoryVaccine/DewormingDiet/SupplementsCurrent work/trainingTrimming/ShoeingAdditional CommentsThe statements above are true and complete to the best of my knowledge. This horse has not received any medication of any kind in the last three weeks (except as mentioned above).Signature of Seller:Date* MM slash DD slash YYYY DOWNLOAD PDF
