Seller Pre-Purchase Exam Form (completed by Seller) Horse's registered name and barn name * Date of birth * Breed * Sex * Color * Tattoo/Brand/Microchip/Registration # * Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Are you a client of Mt. Baker Veterinary? * Has the horse ever been examined/treated by ANY Mt. Baker Veterinary doctors? * Address where horse will be examined? * How long have you owned the horse? * What have you used the horse for and at what level? * What has been the level of training/use of the horse in the last 3 months? * What is your personal estimate of the suitability of the horse for the buyer's proposed use? * Has this horse ever been presesnted for pre-purchase exam before this exam? * If so, when was it examined AND by which veterinarian? * What is the current diet of the horse? * Is the horse on any supplements? (feed or injectable) * When were the horse's teeth last floated? * When were the horse's feet last trimmed/shod? * Does the horse need to have pads on its feet? * When was the horse last vaccinated and with what? * Has surgery been performed on this horse? * Has this horse ever had joint injections? If so, what and when? * Has the horse ever had colic or diarrhea episodes? * Has the horse ever had severe muscle soreness or tying up? * Has the horse ever had dental problems? * Has the horse ever had any diagnosed neurological disorder? * Has the horse ever had a history of respiratory problems or nasal bleeding? * Has the horse ever had any sweating problems? * Do you have any knowledge of ANY past or present health concerns? * Do you have ANY knowledge of past or present lameness/soundness issues? * Has the horse recived ANY medications within the last 6 months? * Are you aware of any behavioral issues (in the stall, on the ground, when ridden, with a farrier or vet, trailering, tying?) * Has the horse had a Cogginns test done or other bloodwork done in the last 12 months? * Any breeding or foaling problems in the past (if intact/applicable)? * Is the horse in foal or exposed to a stallion? * Where has the horse recived veterinary care in the past? * Have you released ALL previous medical history for this horse to the buyer and/or Mt. Baker Veterinary? If no, please include when you return this form. * I the undersigned, certify that I am the owner or authorized owner's agent of the above-described horse. I grant my consent to allow the examination procedures to be performed by a veterinarian of Mt. Baker Veterinary for the purpose of determining the health status of the horse listed above prior to the sale. * Name and signature * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Date * MM DD YYYY Thank you!
