Date:
Purchaser: Phone:
Address:
Present Owner: Phone:
Address:
Location of Examination:
Persons Present During Examination
Buyer/Agent:
Seller/Agent:
Person Requesting Exam:
Horse Identification
Name: Breed: Birth date:
Sex: Color: Height:
History of Surgery/Illness:
Brands/Markings
Face:
LF:
LH:
RF:
RH:
Current Use:
Planned Use:
Body Condition:
Temperament:
Head
Mouth/Teeth:
Ears:
Nostrils:
Larynx:
Jaw:
Cardiovascular Respiratory System
Heart Rate Pre-exercise:
Resp Rate Pre-exercise:
Heart Auscultation:
Lung Auscultation:
Temperature: ºF
CRT/Mucous Membranes:
Pulses:
Jugular:
Trachea (Cough elicited?):
Heart Rate Post-exercise:
Resp Rate Post-exercise:
Lung Auscultation Post-exercise:
Gastrointestinal System
Auscultation:
Vaccination Schedule:
Deworming Schedule:
Ophthalmic Examination
General:
Blink Reflexes:
Left:
Right:
Pupillary Light Reflexes:
Left:
Right:
Anterior Chamber Exam:
Corneal Exam:
Fundic Exam:
Left:
Right:
Musculoskeletal System
Back Palpation:
Left Fore:
Left Hind:
Right Fore:
Right Hind:
Integument:
Scars/Blemishes:
Conformation:
Hoof Tester Examination
Shoes:
General:
Left Fore:
Left Hind:
Right Fore:
Right Hind:
Flexion Tests
Left Fore:
Right Fore:
Left Hind:
Right Hind:
Moving Examinations
Ease of Movement:
Surface:
Straight Line:
Circle Left:
Circle Right:
Gait Abnormalities:
Performance Exam/ Under Saddle Exam:
Radiographic Examination
Blood Testing
Coggins Test:
Drug Screen:
Other:
Reproduction Examination
Overall Evaluation
Recommendations
Said veterinary pre-purchase examination does not warrant the suitability of the horse for the purpose intended and is expressly limited by my statements and instructions on the depth of the examination desired, the specific tests requested and fee paid.
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