Springhill Equine Veterinary Clinic22837 NW 22nd AveNewberry, FL 32669 Pre-Purchase Form PPE Form Fields marked with an * are required Date * Buyer's Name * Buyer's Address * City * US States * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Buyer's Phone * Buyer's Email * Name and phone number of trainer, if involved Name of barn/farm/person where horse currently resides * Address where horse currently resides * City * US States * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Phone number of person where horse is currently residing * Horse's Name * Horse's Date of Birth (year is acceptable) * Breed * Sex * Mare Gelding Stallion Important Notice Important NoticeThe Pre-purchase exam consists of a clinical exam and a moving evaluation. The clinical examination consists of evaluation of the horse’s respiratory, cardiovascular, musculoskeletal, ophthalmic, and gastrointestinal systems. During the moving evaluation, the horse will be examined at a walk and trot in hand, and if possible, longed or circled at the walk and trot in both directions. Providing circumstances permit, flexion tests of the forelimbs and hind limbs will be performed and hoof testers will be applied to all four feet. If the buyer elects to stop the exam at any point due to a perceived lameness, we will not continue to examine the other aspects of the horse. We offer several other possible components to our exam. Please select the services which you would like for us to provide at the time of your pre-purchase exam. Based on the results of the clinical and moving exams, the veterinarian may recommend additional diagnostic tests at the time of the examination to further evaluate exam findings. The pre-purchase exam is expressly limited by your statements and instructions on the depth of the examination desired and the specific tests that you have requested. Radiographs Requested: * Front feet/ Navicular Front fetlocks Knees Stifles Hocks Rear fetlocks Neck Back I DO NOT want radiographs Other Procedures Requested CBC/Chemistry blood test Upper Airway Endoscopy Coggins Health Certificate Drug Screen HTML I, the Buyer, have requested that Springhill Equine Veterinary Clinic perform a Pre-Purchase exam on the aforementioned animal.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 animal. 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 animal. 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. I understand that the examining veterinarian can in no way predict the future performance or soundness of the aforementioned animal, and makes no claims to do so.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. Recurrent colic, tying up, intermittent heaves/equine asthma, pregnancy, impaired vision, anhydrosis, and subtle transitory lameness are some of the conditions that may not be apparent on these exams. EPM can only be definitively diagnosed by spinal tap procedure. HTML Copy If you have not already talked to someone at Springhill Equine about this PPE, please call our office to make an appointment at 352-472-1620. Buyer's Initials * Please type your initials to indicate that you have read and agree with the preceding statement. Divider HTML Payment Information Cardholder Name * Credit Card Number * Exp. Date * Security Code * Billing ZIP Code * HTML Distribution of InformationI 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 Buyer, but Springhill Equine 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 particular discipline are NOT part of this evaluation. Buyer's Electronic Signature * Please list any comments or special notes: Veterinarian's Email for radiographs If you are a human seeing this field, please leave it empty.