DE CILLO

  • PRE PURCHASE EXAM SELLER FORM

  • Date of PPE Exam*
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Medical or Surgical treatments, health and soudness history of this animal

     

  • Has this horse been on medication the the past for illness or to enhance showing/performance ability? (e.g., steriods, bleeder medications, chronic illness, non-sweating, etc.)*
  • Has this horse had any past medical or surgical procedures?*
  • Has this horse had any lameness issues in the past?*
  • Has this horse had joint injections in the past?*
  • Has this horse had any breeding or foaling problems?*
  • Does this horse have any vices or objectionable habits?*
  • Is this mare in foal?*
  • What is her due date?
     - -
  • Does this horse have a current Coggins?*
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  • Does this horse have a history of any sweating problems?*
  • Does this horse have a history of respiratory issues?*
  • Has this horse had any instances of colic within the last 2 years?*
  • Has this horse has not be and will not be treated with any oral, intraveneous, subcutaneous, or intramuscular drugs within 10 days prior to the time of the Pre Purchase Examination*

  • I hereby certify that the above statements are, to the best of my knowledge, true and complete responses to the items asked. I further certify that I am the owner, or duly authorized agent for the above described animal. I hereby grant my consent to the examination of the above named horse by De Cillo Equine Clinic for the purpose of determining the status of horse's health prior to sale.

  • PLEASE BE ADVISED THAT IT IS A REQUIRED SAFETY PROTOCOL AT DE CILLO EQUINE TO SEDATE ALL HORSES FOR ALL DIAGNOSTIC IMAGING INCLUDING BUT NOT LIMITED TO RADIOGRAPHS AND ULTRASOUNDS. THE ATTENDING VETERINARIAN WILL DECIDE THE TYPE AND AMOUNT OF SEDATION REQUIRED. DECILLO EQUINE CLINIC ADMINISTERS THE FOLLOWING SEDATIONS AS NEEDED; XYLAZINE, DORMOSEDAN, BUTORPHANOL, AND ACEPROMAZINE.

    I UNDERSTAND THE SEDATION POLICY AND CONSENT TO SEDATION IF REQUIRED.

  • If you do not agree to the sedation policy, we cannot complete the Pre Purchase Exam at De Cillo Equine. I certify that, to the best of my knowledge, that this horse has not been/will not be treated with any oral, intraveneous, subcutaneous or intramuscular drugs within 10 days prior to the time of the PPE Examination.

    Signature of seller or agent of seller. If this horse has been/will be medicated within 10 days prior to the PPE examination, please list the drug(s), amount, date,

    I HEREBY AUTHORIZE THE RELEASE OF VETERINARIAN MEDICAL RECORDS TO DE CILLO EQUINE CLINIC AND TO THE

  • Format: (000) 000-0000.
  • Date*
     / /

  • Signature of Co-Owner or agent (If applicable) Pre Purchase Exam Seller Form MAY 29 2025

  • Date
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