Trachtenberg Veterinary Associates
481 Penbrooke Dr.
Suite 3B
Penfield, NY 14519
1-585-749-9572
David Trachtenberg, DVM
Amy Ortez, DVM
Prepurchase History Form
Date of History:
Client:
Address:
Phone number:
E mail:
Horse’s Name:
Seller:
Age: DOB
Sex: Breed:
Intended purpose:
Location of Prepurchase:
Performance history:
Color:
Medical History
According to:
Allergies: Skin:
Allergies: Respiratory:
Colic:
Denerving:
Lameness:
Other:
Medications in the last week:
Medical allergies:
Lyme’s:
*Comments:
Respiratory noise:
Surgery:
Vices/behavior problems:
Vision problems:
Back or muscle issues:
HYPP/ EPSM testing:
Supplements:
Neurological issues/ EPM
Strangles:
Preventative Care History Please list dates when given
E & W encephalitis:
EHV (Rhinopneumonitis MLV or inactivated):
Influenza:
Strangles: IN
PHF:
Tetanus:
Rabies:
West Nile:
Other: none
EIA:
Deworming History: Last dewormer type/ date:
Last fecal:
Dental:
Last trim/ reset: