Pre-Purchase Exam Buyer Information

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Tracy R. Walker, DVM, DABVP Equine

Jessica L Harvey, DVM

P.O. Box 2116

1605 Parsons Road

Elkins, WV 26241

Phone: (304)636-8363

Pre-Purchase Examination

Buyer Information
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Client Name:* This field is required.
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Farm Name:
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Phone Number:* This field is required.Include Area Code (xxx) xxx-xxxx
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Cell Phone Number: * This field is required.Please include area code: (xxx) xxx-xxxx
Area Code
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Email:* This field is required.
example@example.com
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Will you be present for this exam?* This field is required.
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If no, please list the agent acting on your behalf.* This field is required.
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Patient Registered Name:* This field is required.
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Registration Number:
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Barn Name:* This field is required.
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Microchip/Tattoo Number:
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Birthdate:
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Age (years) * This field is required.
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Breed:* This field is required.
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Sex* This field is required.
Stallion
Mare
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Spayed Mare
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Color:* This field is required.
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Head/Face:* This field is required.
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Brands/Scars:* This field is required.
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Left Front Limb:* This field is required.
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Right Front Limb:* This field is required.
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Left Rear Limb:* This field is required.
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Right Rear Limb:* This field is required.
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What is the intended use of this horse?* This field is required.Check all that apply.
Pleasure/Trail
Breeding
Competition / Performance
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Competition / Performance (list discipline):
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The base pre-purchase examination fee includes a comprehensive physical exam, dynamic exam with flexions,communications and written report. The examining veterinarian will review the findings of the exam with the potentialbuyer prior to proceeding with further diagnostics. However, some diagnostics must be collected (ie, bloodwork) at thebeginning of the exam. Note that additional fees will apply for each of the following tests requested. An estimate for feesassociated with additional testing will be generated and must be approved prior to proceeding. Would you like to requestany of the following additional exams and diagnostics?
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Would you like to request an insurance exam?* This field is required.
Request
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Please upload insurance forms or email to info@alleghenyequine.com
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Coggin's Test - This test will screen your horse for Equine Infectious Anemia and is required by law for interstate travel and competition. Equine Infectious Anemia ia an incurable blood disease transmitted by mosquitoes. This is required unless current within 10 days of the exam. This test must be submitted to a state diagnostic lab. Results will be available 7-10 working days after the exam.* This field is required.Additional fee
Request
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Certificate of Veterinary Inspection - This is a "health certificate" required for shipment of interstate travel and often required by incoming horses at boarding and training stables. A current Coggin's test is required to complete this certificate.* This field is required.Additional fee
Request
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Complete Blood Count - This is a blood test that monitors for anemia, infection and other possible blood disorders. This test will be completed on site and results should be available during the exam.* This field is required.Additional fee
Request
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Serum Chemistry - This blood test will check kidney function, liver function, muscle enzymes and electrolytes. This test will be completed on site and results should be available during the exam.* This field is required.Additional fee
Request
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34
AQHA 5 Panel DNA Test: HYPP, HERDA, PSSM, MH, GBED. This is a genetic test performed offsite and may take several weeks for results. We recommend that the seller provide results of this panel prior to the exam. Results may affect future performance or breeding plans. If you would like to request this test please indicate below.* This field is required.Additional fee / This may be directly ordered by the current owner from AQHA prior to exam.
Request
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Fecal Exam - This test will screen the patient for several internal parasites. This test is performed on site and results will be available during the exam.* This field is required.Additional fee
Request
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Pre-purchase Toxicology Screening - This test is performed off site and may require 7-10 business days for results. Testing includes acidic and basic drug screens. * This field is required.Additional fee
Request
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Gastroscopy - Note that this procedure will require sedation and the patient must be appropriately fasted for at least 12 hours. This may require an overnight stay.* This field is required.Additional fee
Request
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Upper Airway Endoscopy - This exam is conducted at rest.* This field is required.Additional fee
Request
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Reproductive Ultrasound - This exam includes a rectal palpation and ultrasound of ovaries and uterus or the testicles. This exam generally requires sedation.* This field is required.Additional fee
Request
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Electrocardiogram - This test evaluates the heart for abnormal heart conduction and arrhythmia.* This field is required.Additional fee
Request
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Radiographs: Front feet Complete Navicular Series* This field is required.Each foot is a separate series fee.
Request
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Radiographs: Hocks (minimum 4 views each)* This field is required.Each hock is a separate series fee.
Request
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Radiographs: Stifles (minimum 3 views each)* This field is required.Each stifle is a separate series fee.
Request
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Radiographs: Front Fetlocks (minimum 5 views each)* This field is required.Each fetlock is a separate series fee.
Request
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Radiographs: Carpus (minimum 5 views each)* This field is required.Each carpus is a separate series fee.
Request
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Radiographs: Skull* This field is required.Minimum 4 view. Additional fee for series.
Request
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Radiographs: Cervical Spine* This field is required.Additional fee applies.
Request
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Radiographs: Withers / Lumbar Spine* This field is required.Additional fee applies.
Request
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Is there other specific imaging that you would like to request?* This field is required.Additional fees will apply.
Request
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Other imaging:
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Please list any other specific requests below:
Huge
Large
Normal
Small
Ok
Ok
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Please attach copies of Registration Certificate, current Coggin's test, insurance and other forms here.
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Please read the disclosure statement.* This field is required.
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Printed Name of Buyer* This field is required.
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Signature of Buyer* This field is required.
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