Krause Veterinary Clinic
PHONE: (586) 784-9111
FAX: (586) 784-9416
M.P.Anhalt, D.V.M. 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 Seller’s Form
Name of Horse:
Age:
Breed:
Sex:
Color:
Markings:
1) Current use, level of work, past and anticipated level of competition:
2) Is there anything that you know that might influence the sale and future use of this horse?
3) Is a complete previous veterinary medical history including lameness, surgery, medical conditions,
drug therapy, and joint injections available and from whom?
4)
Duration of current ownership:
5) Currently in work?
Yes
No
6) Has the horse received systemic or intra-articular medication in the last eight weeks? Yes
7) If the answer to #6 is yes, please specify
No
8) Has the horse been lame in the past?
Yes
No
9) Has the horse ever had colic?
Yes
No
10) Previous medical problems?
Yes
No
11) Previous surgery?
12) Vices? Yes No
Yes
13) Behavioral abnormalities?
Other
Yes
Specifics:
No
Cribbing Wind sucking
No
Specifics:
Specifics:
Weaving
Trailer Problems
Head Shaking
Biting
14) Bedding?
Straw
Lives Outside
Shavings
Paper
Other
15) Food?
Please Specify:
Dry Hay
Soaked Hay
Haylage
Beat Pulp Other
16) Husbandry?
Stabled
Turned Out
In and out
17)
When was the horse last shod?
Teeth floated?
18)
Agent(s) Acting on Behalf of Seller:
Phone#:
Address:
Seller’s declaration: To the best of my knowledge the answers to the above questions are correct.
Date:
Print Name:
Address:
Signature of Seller or
Agent:
Phone#:
PLEASE ARRANGE WITH OWNER, BEFORE EXAM, FOR RIDING EVALUATIONS