Seller's Name
*
First Name
Last Name
Mailing Address
City
State
Zip Code
Phone Number
E-mail Address
Horse's Name
*
Horse's Registered or Show Name
Breed
*
Age
*
Sex
*
Gelding
Mare/Filly
Stallion/Colt
Color
*
How long have you owned the horse?
*
What has the horse been used for?
*
Has the horse been actively shown? If so, at what level?
*
What level of work is the horse currently in? (Days per week, duration of work, etc.)
*
Is the horse currently on any medications?
*
Yes
No
If so, which medications and how long has the horse been on it/them?
*
Has the horse had any medical issues that you know of?
*
Yes
No
If yes, please describe below:
Does the horse ever had surgery that you know of?
*
Yes
No
If yes, please describe below:
Has the horse had any lameness issues that you know of?
*
Yes
No
If yes, please describe below:
Has the horse had any joint injections that you know of?
*
Yes
No
If yes, please describe below:
Does this horse have any vices or behaviors to note? (Do they crib, pace, are they bad for farrier/vet. etc.)
*
Has a fecal egg count been run recently? If so, when and what were the results?
*
When was the horse last dewormed and with what product?
*
When were the horse's teeth last floated? Were any dental issues noted?
*
What vaccines has the horse received and when?
*
Please fill in the most recent dates for any vaccines the horse has received below.
When was the horse last shod/trimmed?
*
MM
DD
YYYY
What is the horse's current shoeing/trimming cycle?
*
Please use the space below if you have any other comments about the horse being examined.
