PRe-purchase Seller Buyer Information Buyer's 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 Horse Name * Age * Breed * Colour * Sex * Mare Gelding Stallion Markings * Asking Price (CAD) * Intended Use * Current use of horse * Health History How long have you owned this horse? * What activity is the horse involved in and to what level? * Has this horse been in training in the last 3 days? * Yes No Has this horse been in training in the last month? * Yes No Does this horse display signs of vices and/or problem behaviours? * Yes No Has this horse had prior medical problems and/or surgeries? * Yes No Has this horse had prior and/or current lameness problems? * Yes No Has the horse had any joint injections in the last 6 months? * Yes No Does this horse receive any medication before or after competition? * Yes No Has the horse been examined or treated by a veterinarian in the last 6 months? * Yes No Previous X-rays or Ultrasound? * Yes No Previous injury, illness or colic? * Yes No Has the horse ever exhibited neurological signs? * Yes No Has this horse had any exposure to infectious disease in the past 6 months? * Yes No Has this horse been vaccinated or dewormed this year? Provide dates below. * Yes No Has this horse received any medication in the last month? * Yes No Has this horse had a current negative Coggins Test (EIA) in the last 6 months? * Yes No If you answered "Yes" to any of the above questions, please explain. To 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 Thank you!
