Pre-Purchase Questionnaire
Please fill this form out to the best of your knowledge
Buyer Name
Seller Name
Horse Name, Age, Breed, Sex, Color, Height
All persons expected to be present during time of exam
Please include relationship/title of each person.
Please describe relationship between buyer and horse.
Please explain how long buyer has known horse, if buyer has met horse, and if buyer has ridden horse.
Intended use of horse?
Please describe the discipline and level you intend to ride horse and if you intend to use horse for breeding or re-sale.
Please describe past and current use of horse.
Please include any show/racing records, current and past level of training.
Please provide any known medical history.
Please include any relevant medical history including, but not limited to, breeding, colic, allergies, asthma, cushings, laminitis, vaccination, coggins, and deworming history
Please describe any known history of lameness or injury.
Would you like to have a sedated oral exam performed on the horse?
Please note, we must have permission from seller to sedate horse. I cannot thoroughly evaluate the condition of horse's mouth/teeth without a sedated speculum exam.
Does buyer have any specific concerns regarding this horse?
Please select all blood tests you would like to have performed on the horse today
Drug Screen- Tests for sedatives, pain medications, performance enhancing drugs, etc.
Coggins- Tests for Equine Infectious Anemia
Complete Blood Count- Tests for infection, anemia
Serum Chemistry- Tests kidney, liver, muscle health
ACTH- Recommend if concerned for PPID
Genetic Testing- Can include tests for specific breed concerns
Any additional imaging requests?
Please list any additional diagnostics you would like to have performed at the time of exam.
Please Read and Sign Below
A pre-purchase exam includes a thorough evaluation of a horse including a physical examination of overall appearance, conformation, eyes, ears, heart, lungs, skin, and muscles. In addition to a thorough physical examination, a pre-purchase examination also includes lameness and neurologic evaluations. There will be an additional charge for any bloodwork, x-rays, ultrasound, and endoscopic examination. If you elect to have any x-rays taken of the horse, I do recommend having them evaluated by a board certified radiologist. Please note that a pre-purchase examination is intended only to evaluate the current health status of the horse to aid in the buyer's decision of suitability. I cannot predict future soundness, health, or performance of any horse. In submission of this form, you are demonstrating you understand that neither Dr. Jordan Grossman or Honest Equine Veterinary Services is liable for any future behavioral, medical, or performance issue concerning horse.
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