Pre-Purchase buyer Request Buyer Information Buyer Name * First Name Last Name Buyer's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Buyer's Phone * Country (###) ### #### Buyer's Email * Buyer/Agent Present * Seller Information Seller's Name * First Name Last Name Seller's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Seller's Phone * Country (###) ### #### Seller's Email * Seller/Agent Present * Horse Information Name * Age * Breed * Colour * Sex * Mare Gelding Stallion Markings * Asking Price (CAD) * Intended Use * Please check all the services that you would like to have performed at the time of the exam: 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 We do a standard 4-view series of most joints, 3- view of the stifles and 6- view of the navicular. Only areas of concern: When areas of concern are identified on clinical exam and x-rayed, these will be charged per radiographic view. Hocks Stifles Carpus/Knees Hind Fetlocks Front Fetlocks Front Feet Hind Feet Neck Back Other (Please Specify) Blood Tests Drug Screen CBC & Chemsitry Coggins Other Services Insurance Form Completion Export Form to United States Completion Endoscopy (please specify) Ultrasound Who to contact with findings * First Name Last Name Date * MM DD YYYY Thank you!
