Pre-Purchase Exam History

Name: Central Veterinary Services
Address: 8092 Perimeter Hwy, Oak Bluff, MB, R0G 1N0, Canada
Telephone: 204-275-2038
Price range: $

Start

Fill out the form below.

Please Note: All fields marked with * are required.
If the question is not applicable, please note “N/A” in the corresponding response box.
If you have any questions, please feel free to contact us.

Seller Information:

Seller Name: *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Veterinarian: *

Past/Current Use of Horse: *

Horse Information

Registered Name: *

Breed *

Barn Name: *

Gender: *

Age: *

Height/Weight: *

Color/Markings: *

Tattoo/Brand: *

Location of Veterinary Records: *

Duration of Ownership: *

How long have you owned or known this horse? *

When was this horse last vaccinated? *

Which vaccines were given? *

When was this horse last dewormed? *

Which dewormer was given? *

Please describe training/performance history: *

Please describe work level in the last month and the date/activity of last competition *

When was this horse last trimmed/shod? *

Where is this horse kept? Pasture/Dry/Lot/Stable/etc *

Please describe veterinary examinations/treatments/medications in the last 12 months: *

Has this horse had a recent negative Coggins test? *

Does this horse have any history of lameness or other orthopedic problems? *

Has this horse ever had joint injections? *

Has this horse ever had x-rays taken? *

Does this horse have any history of neurologic disease? *

Has this horse ever had respiratory disease? *

Has this horse ever tied up? *

Has this horse ever had surgery? *

Has this horse ever been bred? *

Is this horse pregnant (if mare)? *

Does this horse have any vices (cribbing, wind-sucking, weaving, biting)? *

Has this horse ever had a vaccine reaction? *

Is this horse currently on any medications/supplements? *

Has this horse ever been on medications? *

If you answered “YES” to any of the above questions, please explain: *

The above statements are true and complete to the best of my knowledge. I, the undersigned, certify that I am the owner of the above described animal. I hereby grant my consent to allow the examination procedures to be performed by an associate of Central Veterinary Services for the purpose of determining the health status of the horse listed above prior to sale.

Signature *

Clear Signature

Date *

Ready to Visit?

We offer tele-triage services outside of normal clinic hours for all current clients and emergency on-call services for our large animal clients. We are located just outside of Winnipeg on the Perimeter highway three miles East of Oak Bluff. We are on call for emergencies on Sundays.

Appointment

Contact Us



Visit Us

8092 MB-100, Oak Bluff,
MB R0G 1N0 Canada

Call or Text Us

P: 204-275-2038
F: 204-261-0556

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Email Us

E: info@centralvet.ca

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Hours

M: 7:30 AM - 5:30 PM
T: 7:30 AM - 6:30 PM
W: 7:30 AM - 5:30 PM
Th: 7:30 AM - 6:30 PM
F: 7:30 AM - 5:30 PM
Sat: 8:30 AM - 5:30 PM
Sun: Closed

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Last

Email *

Phone

How can we help you? *

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