Pre-Purchase Exam Disclosure Form Buyer Note: At High Country Veterinary Services, we endeavor to provide a thorough exam of those organ systems available for examination, in order to provide an accurate picture of the horse in its current condition. We cannot predict the future, and our report is not intended to be a guarantee of future performance. We are not responsible for determining the accuracy of any information provided by the seller of the horse in question.Purchaser Name(Required) First Name Last Name Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number(Required)Email(Required) Date of Examination MM slash DD slash YYYY Doctor completing exam Agent (if applicable) Full NameName of Horse(Required) Age of Horse(Required) Sex(Required) Mare Gelding Stallion Unknown Breed(Required) Color(Required) Date of most recent vaccines(Required) MM slash DD slash YYYY Vaccines Given Previous Use of Horse Intended Use of Horse(Required) Do you intend to breed this horse?(Required) Yes No Maybe Is this horse a resale prospect (investment)?(Required) Yes No If yes, what time frame? Are radiographs requested as part of the exam?(Required) Yes No If veterinarian feels necessary Are you interested in special diagnostics (endoscopy, ultrasound, blood work, etc.)(Required) Yes No If veterinarian feels necessary If yes, which of the following? Blood Work Endoscope Ultrasound Sedated Oral Exam Other If other, please define. Are you interested a drug screen?(Required) Yes No If veterinarian feels necessary Please list and special concerns:A pre-purchase exam should be used along with the buyer’s common sense and knowledge regarding the horse. The exam is just one of several tools used to understand a horse’s unique problems and how best to manage those issues in light of age, history, performance record, prior health records, and intended use. The exam does not waive buyer’s duty to exercise buyer’s own due diligence in investigating the horse’s prior history. IT IS A BUYER’S ULTIMATE RESPONSIBILITY TO DETERMINE IF A HORSE IS SUITABLE FOR BUYER’S INTENDED USE AND PURPOSE. For this reason, it is suggested buyer request seller’s written authorization to release horse’s prior treatment records from the relevant veterinary clinic(s). Similarly, per AAEP guidelines, any known invasive surgery, disease, injury or congenital defect of the horse which is not readily apparent should be disclosed by Seller and/or Seller’s Agent to the intended buyer and/or this veterinary practice. During the exam, we may determine issues that suggest the need for additional testing methods or procedures. Buyer may ask that certain procedures not be performed for a variety of reasons. Limitation of recommended diagnostic tests or procedures may impact the ability of this veterinary practice to identify potentially relevant health or performance issues for this horse. Blood tests are recommended in all instances, and the clinic will hold same for a period of thirty (30) days following the exam. Buyer has requested a licensed veterinarian of High Country Veternary Services (HCVS) to perform a Pre-Purchase Examination on the above named horse. Buyer has also been made aware of any possible conflicts of interest if present, such as being the seller's veterinarian which could introduce conscious or unconscious bias to the examination, and has still made the decision to retain our services regardless of this potential conflict of interest. In order for the undersigned to obtain the benefit of a fee which includes a lesser allowance for risk funding, the undersigned agrees to limit HCVS liability arising from its professional acts, errors or omissions related to this pre-purchase examination such that the total liability of HCVS shall not exceed total fees paid for the examination services rendered in this particular pre-purchase examination. Signature of Buyer(Required) Δ
