Seller Disclosure Form

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Seller Disclosure Form

Please complete this form as completely and accurately as possible so we can get to know you and your animal(s) before your visit.

Pre-Purchase Examination Seller's Questionnaire

Seller Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is this address where the horse is stabled? *

If not, where is the horse stable? *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is GPS reliable for getting you to this address, or would you prefer to include extra directions? *

Yes, the GPS is reliable.
I'd like to include extra directions.

Phone *

Cell *

Email *

Name of the horse *

Age *

Breed *

Registered *

How long have you owned this horse? *

From where/whom did you purchase the horse? *

What has the horse been used for during the time that you have owned the horse?

When was the last vaccination? *

Vaccines given? *

When was the last deworming? *

Dewormer given? *

When was the last shoeing or trimming of the feet? *

How often do you have this (shoeing/trimming) performed? *

When was the last dental care performed if known?

During the time that you have owned this animal, has it:

Had any lameness or performance problems (if so please explain): *

Had any episodes of colic/intestinal upset: *

Had to have any joint injections: *

If so, what/when/why?

To your knowledge has this animal ever had any surgical procedures performed including colic surgery: *

Do you have knowledge of any conditions that may impact the horse's ability to perform as the buyer intends? *

Is the horse on any daily supplements or medications? If so, please list: *

Has this horse had any medication in the last 48 hours? If so, please list: *

Do you grant permission for the following:

Release of prior veterinary records including medical notes and any imaging if available? *

Sedation if required for x-rays, oral exam or any other procedures as part of the examination: *

Remove front shoes if required for foot/navicular x-rays: *

I understand that providing false information or selling a horse under false pretenses is an act of fraud. The answers provided here are truthful to the best of my knowledge. *

I Agree and Understand

Signature *

Clear Signature

Printed Name *

Date *

Seller Disclosure Form

Seller Disclosure Form

Pre-Purchase Examination Seller's Questionnaire

During the time that you have owned this animal, has it:

Do you grant permission for the following:

Questions?

Location

Contact Information

Hours