Pre-Purchase Questionnaire

In Preparation for the Up-Coming Pre-Purchase Evaluation, Please Complete this Questionnaire
Purchaser
Name*
Address
Street Address Address Line 2 City State ZIP Code
Phone*
Purchaser's Agent
Seller/Agent
Name*
Address
Street Address Address Line 2 City State ZIP Code
Phone*
Current Trainer
Currently Boarded At
Patient
Name
Age
Gender
Breed
Color
Brand
Markings
Intended Use
History/Disclosure
History Provided by
Length of Time with Current Owner
Is the Horse Currently in Work
- Yes
- No
Comments
Proposed Use of Horse
Has the Horse Been Worked Today? (to be noted on day of appointment)
Vices
Deworming Date
Date Format: MM slash DD slash YYYY
With
Vaccinations
Date
Date Format: MM slash DD slash YYYY
Last Coggins Date
Date Format: MM slash DD slash YYYY
FEI Passport
- Yes
- No
Is the Horse Currently Insured
- Yes
- No
Is the Horse on any Medications
- Yes
- No
Comments
Have any Medications Been Given in the Last 48 Hours
- Yes
- No
Comments
Medical History
Dental History
Surgical History
Musculoskeletal/Lameness History
Other Comments
Disclosure: I certify, to the best of my knowledge, that the above information is true and correct.
Signature Owner/Agent*
Date*
Date Format: MM slash DD slash YYYY
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Phone
This field is for validation purposes and should be left unchanged.

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Purchaser