Prospective Buyer *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Phone *

(###)

###

####

Will buyer be present for exam? *

Yes

No

I (the buyer) authorize my named agent to make decitions about the examination/ancillary testing in my place.

Yes

No

Gender

Gelding

Mare

Stallion

Will medical records be released for review? (If yes, please email records to ponymd@outlook.com prior to exam date)

Yes

No

It is important to remember that the pre-purchase examination can only give information about the horse's health and condition on the day of the examination. The examination findings are not a warranty, express or implied, of future health, soundness, or suitability. The veterinarian's role in the pre-purchase examinationis not to "pass" or "fail" the horse. Instead, it is to help you make an informed decision by providing information about the horse's health and soundness on the day of the exam. By checking th box below you are indicating that you understand that there are limitiations to the pre-purchase evaluation and certain conditions may not be detectable on the day of the examination. You also agree not to hold Commonwealth Equine liable for conditions that may present themselves in the future that could affect performance or resale. Ultimately, the decision to purchase the horse can only be made by the prospective buyer.: *

By checking the box, I (the buyer) indicate that I have read and understood the above information.