Pre-Purchase Exam

Request for Pre Purchase Exam

Horse's Name: _____________________________________
Age: Colour: Breed: Sex: Male / Female / Gelding
Brands: Microchip:

Purchaser
Address
Phone

I hereby request that Dr Brett Warren of CCEP performs a pre-purchase examination of the horse described above.
- The proposed purpose for the horse: _____________
- Asking price (optional): __________

I understand the examination will be carried out substantially in accordance with the Equine Veterinarians Australia guidelines. I request in addition the following proceedures:
Radiography specific areas __ ____________________
Uppper airway endoscopy
Ultrasound examination
Examine at work
Blood/Urine drug screening
Other:

I undertake to use this information solely in the prepurchase evaluation of this horse and will not divulge this information to any third part or for any other purpose.

I accept responsibility for payment of veterinary fees associated with this examination.



Signed: Date:
Purchaser/Agent