PRE-PURCHASE EXAMINATION SELLER QUESTIONAIRE
Horse's Name * Date of Report
Seller's Name *
Seller's phone number *
Seller's Email Address Seller's Agent
Buyer's Name *
Horse's Year of Birth
How long has seller owned this horse?
Current use of horse
Will medical record be released for review? (If yes, please email to email@example.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. *