HomePre Purchase QuestionnairePre Purchase QuestionnaireNameThis field is for validation purposes and should be left unchanged.Buyer InfoName* First Last Cell Phone*Home PhoneAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Buyer's Agent's Name* First Last Buyer's Agent's Phone*Seller/Agent InfoName* First Last Cell Phone*Home PhoneAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Current Trainer's Name First Last Current Trainer's PhoneHorse InfoName*Barn Name*Breed*Age*Gender*--MaleFemaleIntended use of horse*Have you ridden the horse?*--YesNoHistory/DisclosureHistory provided by:*Length of time with current owner*Is the horse currently in work?*--YesNoIf so, describe the workVices:Deworming Date* MM slash DD slash YYYY Dewormed with:* First Last List of vaccinations and dates:*Date of last coggins:* MM slash DD slash YYYY Has FEI Passport?*--YesNoIs the horse currently insured?*--YesNoIs the horse on any medications?*--YesNoIf on medications, which one(s) and what dose(s)?Medical History*Surgical History*Lameness History*Dental History*Other comments:Please note: this is not a pass or fail examination. Our goal is to provide you with information to help you to make an informed and comfortable decision on whether or not to proceed with the purchase of the horse in question. Please select the services below you would like performed for the pre-purchase exam of this horse. If you have questions about any of the tests listed below please call our office.We encourage you to speak with one of our veterinarian prior to the exam to discuss any specific concerns you may have. It is ideal for the buyer to be present for the exam if possible.Pre-purchase Clinical and Moving Examination:The clinical examination begins with a comprehensive evaluation of the horse's respiratory, cardiovascular, musculoskeletal and gastrointestinal systems. A through palpation examination of all the limbs, neck and back is also performed. During the moving evaluation, the horse will be examined at a walk and trot, and lunged and/or observed under saddle at the walk, trot and canter in both directions. In addition, flexion tests of the forelimbs and hind limbs will be evaluated. Please ensure that there is an appropriate and safe area to trot and canter the horse. Please arrange for a competent rider and tack to be available for the exam.Digital Radiographic (X-Ray) Examination:Following the moving examination, the horse will proceed to radiographs. It is standard in our X-Ray examination, to remove the horse's front shoes in order to obtain the best quality radiographs of the front feet. Specific radiographs to be taken will be discussed between buyer and veterinarian performing the exam prior to taking X-Rays. More advanced diagnostics such as ultrasound may be indicated if swelling, thickening, or sensitivity of the tendons or ligaments is palpated.Blood work: A CBC/Chemistry panel provides critical information to asses subclinical infection, muscle enzymes, kidney, liver, and other organ functions. (Please allow 2 working days for results). In addition, we can perform testing for endocrine conditions, or diseases we see in our location including lyme disease or vitamin E/Selenium deficiency. (Please allow 7 business days for endocrine and deficiency testing).Please select which blood test you are interested in: CBC / Chemistry Lyme Multiplex Vitamin E / Selenium ACTH (Cushing's) Insulin Leptin (Equine Metabolic Syndrome) Purchase Exam AcknowledgementThe benefits of the above described tests/radiographs have been explained to me and I am indicating my decision regarding these tests by checking the boxes above. I acknowledge that the pre-purchase examination is intended to provide me, the buyer, with an opinion of the condition of this horse prior to purchase. This opinion is based solely on what is found on the day of examination and is not meant to be predictive of future soundness and usability as this can be greatly influenced by other factors. While the goal of the pre-purchase examination is to assess the health and soundness of this horse on the day of examination, I understand that there are limitations to these clinical, radiographic, and laboratory examinations and certain conditions that could be affecting this horse may not be seen or discovered. I understand that it is my choice to decline any of the services of this examination that are offered by the veterinarians of McGee Equine Clinic and that McGee Equine Clinic cannot be held liable for conditions that may come to light in the future.Please initial here to acknowledge the above statement:*Date of acknowledgement* MM slash DD slash YYYY Buyer's Signature*CAPTCHA
