Krause Veterinary Clinic
PHONE: (586) 784-9111 FAX: (586) 784-9416
D.A.Krause, D.V.M
S.A. Nebergall, D.V.M
C.L. Munsell, D.V.M K.A. Long, D.V.M
Prospective Buyer’s Form
Buyer’s Name_____________________________________________________
Phone #: (home)__________________(cell)____________________________
Buyer’s Email_____________________________________________________
Fax #:___________________________________________________________
Address:________________ __________________________________________
Agent (s) acting on behalf of Buyer (if any): __________________Phone #:_________
Intended use of Horse:____________________________________________________
Is the horse to be insured for loss of use or mortality?
Name of Horse:
Age: ________ Breed:_____ Sex: _____ Gelding___ Color _________
Markings: __________________________________________ Brand/Tattoo: ________
Examination procedures requested (Please Check Box):
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7.
 Pre-Purchase Examination (Standard): Start @ 200.00
 Coggins Test: $35
 Complete Blood Count: $40  Fecal Exam: $15  Chemistry Panel: $65
 Radiographs: First Film $60 Additional Films $40 Each
 Insurance exam: $25 (Please have on hand or FAX a copy of forms to be filled out)
 Drug testing: Must be performed day of exam. Charges subject to lab used.
Faxing & Fed Ex Charges will be additional.
The pre-purchase examination is intended as an aid to assist a prospective buyer. The
examiner will neither imply nor make a warrantee. Examination is undertaken at the
expense of and for the exclusive use of the buyer. All comments, findings, and
recommendations of the examiner are made in his/her opinion and to the best of his/her
knowledge at the time of the examination.
Many subtle internal medical or musculoskeletal problems are difficult to diagnose or
may go unrecognized on a purchase examination. Recurrent colic’s, “tying up,” low
grade bronchitis, exercise induced pulmonary hemorrhage, pregnancy, impaired vision,
non-sweating, sub-clinical Cushing’s syndrome, early neurological disease such as EPM
or cervical facet arthrosis, and subtle lameness are some of the occasional conditions
undiagnosed on routine examinations.
It is recommended that the buyer or the buyer’s representative has ridden the horse in the
discipline and at the intensity of work that is intended prior to examination.
I request that the above described horse be examined for purchase. Examination
procedures not checked are waived as part of this examination.
Date: _________Signature of Buyer or Agent: ____________