Harmony Veterinary Services, LLC
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PRE-PURCHASE EXAMINATION SELLER QUESTIONAIRE
Horse's Name *                                                                           Date of Report

Seller's Name *

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Seller's phone number *

Seller's Email Address                                                                Seller's Agent

Buyer's Name *

Horse's Year of Birth
Color

Breed


How long has seller owned this horse?
Current use of horse

Current veterinarian

Will medical record be released for review? (If yes, please email to harmonyveterinary@gmail.com prior to appointment)
Date of last negative Coggins test

Date of last Rabies vaccine                                            Date & List of last Core Vaccines

Date of last dental float                                                  Date and Medication used for last deworming

History of colic surgery?

History of laminitis?

History of neurectomy ("nerving")?

History of "tie back"(throat) surgery?

Describe any history of lameness or medical issues:





Current diet: Hay and grain - amount and type
Daily supplements? Please list
Daily medications? Please list




By checking the following box, I, the seller of the horse indicated above, verify that the information above is, to the best of my knowledge, complete and correct. *

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