Align Equine Declaration of Health

To be completed by the owner of the horse, or person responsible for the horse. Before answering any question, read carefully the paragraph at the end of the declaration that you are required to sign. Comment on any "yes" answers in the comments section below.

Owner Name*

First NameLast Name

Purchaser Name*

First NameLast Name

Name of Horse*

Age*

Sex*

Breed*

Has the above horse ever suffered from any fracture, lameness, tendon or ligament injury, joint disease?*

YESNO

Has the above horse ever suffered from any accident or illness or undergone surgery?*

YESNO

Has the above horse ever had any incidence of colic or gastro-intestinal disorders and/or ulcers?*

YESNO

Is the above horse currently receiving any non-steroid anti-inflammatory or analgesic medication?*

YESNO

Has the above horse ever received any joint injections?*

YESNO

Has the above horse ever been nerved, undergone diagnostics (ultrasound, x-rays, etc) or received treatment for lameness?*

YESNO

Has the above horse ever been treated for melanomas, sarcoids or other tumors?*

YESNO

To your knowledge does the horse suffer from or display any objectionable behaviours such as cribbing, stall weaving, pacing.*

YESNO

What is horse fed daily, including supplements? *

Comments

I hereby certify that, to the best of my knowledge and belief, the above particulars are true and correct and that no information has been withheld. I also certify firsthand knowledge of the health and condition of the horse. I have signed this declaration of health in the full knowledge of all treatments performed on the horse. It is understood that any disputes pertaining to the previous health and veterinary records of the above stated horse are between the purchaser and seller. The veterinarian can only attest to the state of the horse as described in the pre-purchase examination.

Signature of Owner*

Date*

Date

DECLARATION OF HEALTH