Pre-Purchase Examination

Buyers Name *

First Name

Last Name

Owned by: *

Owners Name

First Name

Last Name

Seller *

First Name

Last Name

Seller Phone Number *

(###)

###

####

Are you an established client of TREVS? *

YES

NO

Purchaser *

First Name

Last Name

Purchaser Phone Number *

(###)

###

####

Are you an established client of TREVS? *

YES

NO

Will you be at the exam or have an agent or witness stand in your place? *

Please select one

I will be at the appointment

I will not be at the appointment

I will not be at the appointment; but will be on standby for a phone call

Agent / Witness

First Name

Last Name

Agent / Witness Phone Number

(###)

###

####

Are you an established client of TREVS?

YES

NO

Current Veterinarian *

First Name

Last Name

Phone Number *

(###)

###

####

Sedated Oral Exam *

Yes

Maybe

I do not want a sedated oral exam

Radiographs *

Spine

Hocks

Stifles

Front Feet

Neck

I do not want radiographs

Other (Please List)

I am not sure

Bloodwork *

CBC / Chemistry

Coggins & Health Certificate (required for out of state travel)

Drug Screening Panel

Other (please list below)

I do not want bloodwork

Ultrasound *

Yes

Maybe

I do not want an ultrasound

Endoscopy *

Yes - Gastric

Yes - Upper Airway

I am not sure

I do not want an endoscopy

Fecal Egg Count *

Yes

Maybe

I do not want a fecal egg count

Insurance Exam *

Please email your insurance forms to our office before your appointment.

Yes

I do not want an insurance exam

The purchaser intends to insure this horse for: *

Major Medical and Surgical

Mortality

Loss of Use - If you would like Loss of Use, we would like to have a copy of the form so we can take appropriate radiographs. In addition, a CBC and Chemistry may be required, as well as stifle radiographs.

I do not intend to insure this horse

Other (please list below)

Seller & Buyer: *

I understand that Tumalo Ridge Equine Services, LLC is giving an opinion on the horse presented. Tumalo Ridge Equine Services, LLC gives the best opinion from examining the horse on a particular day. Tumalo Ridge Equine Services, LLC cannot predict the future of any horse. Every horse has a different pain tolerance, therefore is impossible to be positive on any given day that no sub-clinical problem exists. Tumalo Ridge Equine Services, LLC does not issue a warranty on any horse. If such a warranty is desired by the buyer, it should be discussed and contracted with the seller. A pre-purchase exam is performed for the buyer and not the seller. It is the buyer’s responsibility to inform Tumalo Ridge Equine Services, LLC of what diagnostics, radiographs, and bloodwork are to be performed. When the horse is examined, it will not receive a pass or fail. The decision to buy a horse can only be made by the buyer. Tumalo Ridge Equine Services, LLC does not determine the suitability, talent or value of the horse examined. Radiographs taken during the exam are part of the legal medical record and are the property of Tumalo Ridge Equine Services, LLC. Radiographs will only be mailed/emailed to veterinarians requesting them and only after the bill has been paid.

First Name

Last Name

Date *

MM

DD

YYYY

*

I agree to electronically sign this document by typing my name.

IF SELLER OR AGENT IS A PAST OR CURRENT CLIENT of Tumalo Ridge Equine Services, LLC PLEASE READ AND SIGN BELOW:

A potential conflict of interest exists when a veterinarian from our office examines a horse owned by a client of this practice. The seller must realize that in this situation the veterinarian performing the examination is working for, and in the sole interest of, the purchaser. The seller should realize that because our office has records and history relating to the horse in question and can only conduct the prepurchase examination with full disclosure of all information available, we are in a unique and sometimes overly knowledgeable position to find fault with the animal in question.

First Name

Last Name

Date

MM

DD

YYYY

I agree to electronically sign this document by typing my name.

Seller

I, the undersigned, certify that I am the owner or authorized agent of the above-described animal. I hereby grant my consent to allow the examination procedures to be performed by a veterinarian of Tumalo Ridge Equine Services, LLC for the purpose of determining the health status of the horse listed above prior to sale. The seller’s signature below indicates the seller has read these statements and agrees to hold harmless Tumalo Ridge Equine Services, LLC and the examining veterinarian from any real or perceived loss in the present or future value of the horse as a result the examination and the opinions rendered therein.

First Name

Last Name

Date

MM

DD

YYYY

I agree to electronically sign this document by typing my name.

Purchaser

The pre-purchase examination reflects the health and soundness of the horse on the day of the evaluation and is no guarantee of future soundness and suitability. The examination is not intended to be used as a prognosis for future health, soundness or a warranty for the horse’s suitability for any future use or purpose. The veterinarian’s job is neither to pass nor fail the animal being examined. The determination by the buyer to purchase the animal examined is solely buyer’s choice and responsibility. The buyer should be aware that this examination does not encompass an in-depth evaluation of the horse's temperament, ability, or aptitude for a particular discipline. It describes the horse's health and soundness on the day and time of the examination. A routine prepurchase examination may not reveal subtle unsoundness, especially if the horse has not been in hard/consistent work in the preceding months. The veterinarian is also dependent on the information, records and statements provided. Buyer acknowledges that a material condition of Tumalo Ridge Equine Services, LLC agreement to perform this prepurchase examination is buyer’s agreement to release, waive and discharge Tumalo Ridge Equine Services, LLC, its veterinarians and employees, from all claims arising directly or indirectly from the performance of the prepurchase examination The purpose of this pre-purchase examination is to offer a professional opinion as to the present general health, condition, and serviceability of the above-named horse. Professional opinions and judgments as to the future serviceability and soundness of this animal may be offered as possible help and assistance to the buyer or their agent in the decision to accept or reject this horse. The horse will not receive a “pass” or “fail.” The decision to buy can only be made by the buyer. Only the buyer can decide if the horse’s talent, suitability, disposition, or value meet his/her satisfaction. No other specialized examination techniques were included in this exam unless specifically requested and recorded. If the buyer wishes to obtain a warranty covering exact age, height, freedom from vices, the non-administration of drugs prior to this examination, future soundness, or the animal’s breeding or performance history, such warranty should be obtained from the seller as these are not the responsibility of the veterinarian. Some subtle internal medical or musculoskeletal problems are difficult to diagnose or will not be apparent on a routine Pre-Purchase examination.

First Name

Last Name

Date

MM

DD

YYYY

I agree to electronically sign this document by typing my name.

Distribution of Information

I understand that it is the veterinarian’s responsibility to provide information to Buyer, who will then use said information as they see fit. The information generated by this exam belongs to the Buyer, but Tumalo Ridge Equine Services, LLC may share this information with the seller of the horse at Buyer’s request. This veterinarian will NOT “Pass” or “Fail” this horse but will only provide any and all evaluative findings. I also understand that this horse’s monetary value and suitability for any discipline are NOT part of this evaluation.

First Name

Last Name

Date

MM

DD

YYYY

I agree to electronically sign this document by typing my name.