Pre-Purchase Exam - Buyer Form

Pre-Purchase Exam - Buyer Form

To be completed and returned at least 48 hours before appointment.
Name*

First NameLast Name
Email*
example@example.com
Phone Number for Day of Appointment*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Contact

Trainer, coaches etc. allowed to be contacted during appointment.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Legal Land Description - Horses Current Location *
Directions to Pre-Purchase Exam location: *
Information Release
Do you give permission for information obtained during pre-purchase exam be released to seller?*
What is your intended use/disipline for this horse? *
Do you have any concerns in regards to this horse? *
Please select all options you want to be included in the pre-purchase exam.

All costs have been included and by selecting the options, you agree to the costs, and confirm by signature.
Pre-Purchase Exam (PPE): includes Full Physical Exam, Flexions and Report. I understand that the cost of a PPE is $300 per hour with a minimum $300 charge.*
Radiographs (includes setup fee)*
Images/Joints Requested in PPE Exam. These images will be taken before calling to discuss findings.
Equine Infectious Anemia (Coggins) $90.00*
Full Drug Panel (Sedation, NSAIDs, etc) $407.00*
CBC/Biochemistry $141.25*
ACTH/Insulin/Glucose $130.00*
Rectal Ultrasound (Reproductive Tract, Bladder, etc) $95.00*
Endoscope (Upper Airway, Static, Unsedated) $150.00*
Gastroscope (Sedated & Fasted) $300.00 + Sedation. Requires signed permission from seller for sedation.*
If you have additional tests/examinations you would like, please list below or type N/A: *
Signature*
Should be Empty:

Pre-Purchase Exam - Buyer Form

Alternate Contact

Information Release