Heritage Place

BROOD MARE ONLINE SALE

ENTRY QUESTIONNAIRE
Please fill out the following questionnaire according to horse type. All questions should be answered.
HORSES SOLD AS BROODMARE / BROODMARE PROSPECTS
List Sale Broodmare / Broodmare Prospects Sold
Horse name
HIP
Consignor
Is this horse a cribber?

YesNo
Does this horse have a slight defect?

YesNo
If you answered yes please explain.
Has this filly / mare ever been bred?

YesNo
Has this filly / mare shown any lameness in the past 30 days?

YesNo
Does this horse have any noticeable scars or cosmetic blemishes?

YesNo
If you answered yes please briefly explain.
Does this horse have any deviation from the norm in one or more hooves?

YesNo
If you answered yes please briefly explain.
Is this horse / shod wearing shoes?

YesNo
If you answered yes please briefly explain.
IF YES TO ANY OF THE FOLLOWING, VET REPORT MUST BE SUBMITTED IN REPOSITORY:
Has this horse had any abdominal surgeries in the last two years?

YesNo
If yes, was there any resection of an abdominal organ (partial or complete) except to repair a ruptured bladder in a newborn foal ?
Has this mare had a rectovaginal laceration with in the last two years?

YesNo
Has this mare had a surgery involving the cervix within the last two years?

YesNo
Has this mare had a urethral extension within the last two years?

YesNo
Has this mare had a surgical removal of an ovary within the last two years?

YesNo
If yes, to any of the above.

YesNo
If yes, to any of the above, please desribe, date/surgery type/name of vet, etc.
Are there any other conditions, surgeries, or details to disclose that are not listed above, please do so here:
I, the consignor, herby accept full responsibility for the content of this form and release Heritage Place, Inc from any and all liability regaurding its veracity and accuracy.
Signature
Date

MonthDayYear
Date
Email
example@example.com
Should be Empty:

BROOD MARE ONLINE SALE