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.
Alternate Contact

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

First NameLast Name
Phone Number
Please enter a valid phone number.
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?*

YESNO
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.*

YESNO
Radiographs (includes setup fee)*

2 Views $160.00Additional Views $45.00Per joints (4 views or more) $220.00Whole Body (minimum 32 views) $1600.00N/A
Images/Joints Requested in PPE Exam. These images will be taken before calling to discuss findings.
Equine Infectious Anemia (Coggins) $90.00*

YESNO
Full Drug Panel (Sedation, NSAIDs, etc) $407.00*

YESNO
CBC/Biochemistry $141.25*

YESNO
ACTH/Insulin/Glucose $130.00*

YESNO
Rectal Ultrasound (Reproductive Tract, Bladder, etc) $95.00*

YESNO
Endoscope (Upper Airway, Static, Unsedated) $150.00*

YESNO
Gastroscope (Sedated & Fasted) $300.00 + Sedation. Requires signed permission from seller for sedation.*

YESNO
If you have additional tests/examinations you would like, please list below or type N/A: *
Signature*

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Pre-Purchase Exam - Buyer Form

Alternate Contact

Information Release