Prepurchase Examination Request Form

If you have not already filled out a Veterinary Services Contract it must be done as well as the Prepurchase Request Form- thank you!

Prepurchase Examination Request Form

PLEASE BRING TACK AND BE PREPARED TO RIDE.

Purchaser's Info
Purchaser's Name
First Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Purchaser's Agent
First Last
Phone
Horse Info
Name of horse being examined
Intended use of horse
Age
Breed
Sex
Color
Seller's Info
Seller's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Seller's Agent
First Last
Phone
Place of Prepurchase
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Exam Info
The basic prepurchase exam consists of a physical exam which includes examination of the eyes, heart and lungs; hoof tester exam; moving exam; and flexions. The following services are available, but are not included in the basic exam:
Radiographic Exam
- Front Feet
- Knees
- Stifles
- Front Fetlocks
- Hocks
Ultrasound Exam
- Tendons
- Suspensories
- Reproductive Tract
Endoscopic Exam
- Airways
Blood Work
- CBC/Chemistry
- Drug Screen
- Coggins
- Additional examination to be left to the discretion of the examiner
Riding*
- I understand that the exam will require riding, and will bring tack and be appropriately prepared for such.
Payment Authorization*
- I understand that a valid credit card number will need to be supplied and that card will be charged for the full amount of the Prepurchase Exam within 24 hours of the completed exam. Please contact the office for an estimate of services.
Other requests
Veterinarian's Name
First Last
Date of Appointment

Contact Us

4122 Zulla Road
The Plains, VA 20198

Phone: 540-364-4950
Fax: 540-364-4987

Phone: 540-364-4954

Location Hours for Equine

Monday 8:00am – 5:00pm

Tuesday 8:00am – 5:00pm

Wednesday 8:00am – 5:00pm

Thursday 8:00am – 5:00pm

Friday 8:00am – 5:00pm

Saturday Closed

Sunday Closed

We are on call 24/7 for emergencies.

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Monday	8:00am – 5:00pm
Tuesday	8:00am – 5:00pm
Wednesday	8:00am – 5:00pm
Thursday	8:00am – 5:00pm
Friday	8:00am – 5:00pm
Saturday	Closed
Sunday	Closed

Prepurchase Examination Request Form

Prepurchase Examination Request Form

Purchaser's Info

Horse Info

Seller's Info

Place of Prepurchase

Exam Info

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