Pre-Purchase Exam Seller 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

Seller Information
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Seller Name:* This field is required.
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Farm Name:
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Address* This field is required.
Street Address
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Country
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Phone Number* This field is required.Include area code (xxx) xxx-xxxx
Area Code
Phone Number
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Cell Phone* This field is required.Include area code (xxx) xxx-xxxx
Area Code
Phone Number
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Email* This field is required.
example@example.com
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How long have you been acquainted with this animal?* This field is required.
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How long have you had this animal under your care?* This field is required.
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Current Use:* This field is required.
Pleasure/Trail
Breeding
Competition/Performance
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Competition / Performance (list discipline):
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Registered Name:* This field is required.
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Registration Number:
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Please upload Registration Papers here or email to info@alleghenyequine.comPlease note that exam date will not be confirmed without receipt of appropriate records.
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Max. file size: 10.6MB
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Barn Name:
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Microchip/Tattoo Number:
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Birth Date:
Date
Month
Day
Year
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Age:* This field is required.
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Breed:* This field is required.
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Sex* This field is required.
Stallion
Mare
Gelding
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:* This field is required.
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Right Front:* This field is required.
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Left Rear:* This field is required.
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Right Rear:* This field is required.
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Is a complete previous veterinary medical history including vaccinations, dental exam, lameness, surgery, medical condition, drug therapy and joint injections available?* This field is required.
YES
NO
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Please upload records here or email to info@alleghenyequine.comPlease note that exam date will not be confirmed without receipt of appropriate records.
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Has this horse been treated with any systemic or intra-articular medications over the last 8 weeks?* This field is required.
YES
NO
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If yes, explain.Include reason for treatment, date of treatment and medications given.
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To the best of your knowledge, has this horse ever had any of the following: (If yes, to any, please note date of occurrence.)
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Colic* This field is required.Medical colic, treatment of gastric ulcers
No
Yes
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Date of Occurrence and Brief Explanation
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Colic Surgery* This field is required.
No
Yes
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Date of Occurrence and Brief Explanation
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Lameness* This field is required.
No
Yes
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Date of Occurrence and Brief Explanation
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Eye/Vision Problems* This field is required.Recurrent Uveitis, cataract, etc
No
Yes
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Date of Occurrence and Brief Explanation
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Surgery* This field is required.
No
Yes
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Date of Occurrence and Brief Explanation
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Use of Medications
NO
YES
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Date of Occurrence and Brief Explanation
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Disabilities* This field is required.
No
Yes
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Date of Occurrence and Brief Explanation
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Vices* This field is required.Cribbing, Weaving, etc
No
Yes
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Date of Occurrence and Brief Explanation
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Behavioral Problems* This field is required.Heading Shaking, Biting, Cribbing, Weaving, etc
No
Yes
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Date of Occurrence and Brief Explanation
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Breeding Problems* This field is required.Abortion/Failure to conceive, Failure to Breed
No
Yes
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Date of Occurrence and Brief Explanation
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AQHA Five Panel DNA Test* This field is required.HYPP, HERDA, GBED, MH, PSSM
No
Yes
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If yes, please upload DNA results here or email to info@alleghenyequine.comPlease note that exam will not be confirmed without receipt of appropriate records.
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Select files to upload
Max. file size: 10.6MB
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If needed, please explain any further information on any of the above stated.
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If mare, is she pregnant?* This field is required.
Yes
No
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Due Date:* This field is required.
Date
Month
Day
Year
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Current Care:* This field is required.
Pasture Only
Pasture/Stall
Stall Kept Only
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Current Activity Level* This field is required.
Not currently in work
Currently active in intended use
Retired
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When was the horse last trimmed or shod?* This field is required.
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Is there anything that you may know that may influence the sale of this animal?* This field is required.
Yes
No
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Please explain.
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Will you be present during the exam?* This field is required.
Yes
No
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If no, please name the agent that will be representing you.
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I, {sellerName}, certify that I am the owner, or duly authorized agent of the owner the above stated equine, {registeredName}. To the best of my knowledge, the answers to the above questions are true and correct. I hereby grant my consent to allow the examination procedures, including sedation, to be performed by Allegheny Equine Veterinary Service for the purpose of determining the health status of the equine listed above for sale. I understand that the findings of the exam are the property of the potential buyer and that the examining veterinarian will not discuss with me (the seller) without explicit permission from the potential buyer.
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Signature of Seller* This field is required.
Clear
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Date
Date
Month
Day
Year
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