Pre-purchase Exam - Seller Questionnaire Seller Name * First Name Last Name Phone * (###) ### #### Email Agent Ownership How long has the seller owned this horse? Horse Name * Birth Year * Gelding Stallion Mare Color Breed Current Use How is the horse used currently? Current Veterinarian Medical Records Will records be released for review? Yes, records will be emailed to harmonyveterinary@gmail.com prior to appointment Last Negative Coggins MM DD YYYY Late Rabies Vaccine MM DD YYYY Last Dental Float MM DD YYYY Other Vaccines Date and list other vaccines Last Deworming Date and medication for last deworming Surgical History History of colic surgery History of laminitis History of neurectomy ("nerving") History of "tie back" (throat) surgery Other Describe any history of lameness or medical issues Diet List: amount and type of hay, grain, supplements, medications Signature * I, the seller of the horse indicated above, verify that the information provided is, to the best of my knowledge, complete and correct. Thank you!
