VETERINARIAN CERTIFICATE OF EXAMINATION FOR FOAL MORTALITY INSURANCE
The following must be completed by a licensed veterinarian
NOTE: ORPHAN FOALS UNDER 90 DAYS OF AGE ARE UNINSURABLE
Horses being examined for insurance should be moved about outside the stall and viewed from front and back to demonstrate soundness of limb
and freedom of movement. Careful observation and inquiry should be made as to housing conditions and the presence of contagious diseases.
This certificate should be completed by the examining veterinarian to the best of their ability as a licensed veterinarian and forwarded to the
insurance agent without delay.
FOAL HISTORY
Sire ___________________________________________ Dam _____________________________________________________________
Date of Birth _____________________________________Hour of Birth __________________________________________________
Color _________________________ Sex ______________Markings ___________________________________________________
EXAMINING VETERINARIAN, PLEASE PROVIDE THE FOLLOWING INFORMATION IF AVAILABLE TO YOU:
1. Was parturition complicated in any way? ________________________________________________________________________
2. Time lapsed prior to foal first receiving colostrum? __________________________________________________________________
3. (Did) (Does) the mare have adequate milk? _____________________________________________________________________
4. (Is) (Was) supplement milk being fed? If so, give particulars _________________________________________________________
___________________________________________________________________________________________________________
5. Did the mare drip or stream milk prior to parturition? ________________________________________________________________
6. Does the mare have a history of producing jaundiced (neonatal isoerythrolysis) foals? _______________________________________
7. How many live foals has the mare produced previously? ______________________________________________________________
8. How many of the mare s foals have survived the weaning age? _________________________________________________________
9. If mare lost any foals, give year lost and cause of death _______________________________________________________________
10. How long was the gestation period? ______________________________________________________________________________
EXAMINATION (Not to be completed prior to 24 hours of age)
1.
2.
3.
4.
5.
Approximate weight of the foal at the time of examination ___________________________________________________________
Time lapse prior to the foal nursing the mare unassisted _____________ Time lapse before the foal stood unassisted _____________
Does mare have to be restrained or will she allow foal to nurse freely? __________________________________________________
Temperature _________________ Heart Rate ______________________ Respiratory Rate _________________________________
Has all of the meconium been passed? _________ What is the consistency of the stool? ___________ _________________________
Has the foal urinated normally? ________________________________
6. Do the heart and lungs sound normal? ___________________________________________________________________________
7. Is umbilical or scrotal hernia present? ____________________________________________________________________________
8. Are both eyes normal? ________________________________________________________________________________________
9. Are the limbs straight? If not, how are they deviated? _______________________________________________________________
__________________________________________________________________________________________________________
10. Are any joints distended? _______ Is the foal lame? ___________ Give Particulars ________________________________________
__________________________________________________________________________________________________________
11. Is milk regurgitated from the nose following nursing? _______________________________________________________________
12. What were the results from the performed IGg assay or serum protein electrophoresis? _____________________________________
13. Is the farm management and sanitation program good? ____ Is there adequate shelter? ____ Is fencing safe and adequate?_________
14. Are there any infectious diseases present on the farm? _____ If so, give particulars ________________________________________
__________________________________________________________________________________________________________
Note: Are there any other areas you feel are relevant to the health of this foal? _______________________________________________
______________________________________________________________________________________________________________
Name of Owner ________________________________________________________________________________________________
Examining Veterinarian __________________________________ Date & Time_____________________________________________
Address ______________________________________________ Office Phone (_______) ____________________________________
City__________________________ State ________ Zip ________Office Fax (______) ____________________________
Signature of Veterinarian _________________________________ License # _________________________ State _________________
Veterinary Certificates are Not Acceptable Unless Received Within 15 Days of Examination.
Equine Insurance Etc.
PO Box 288
Purcell, OK 73080
(817) 457-9362 Fax (817) 446-0034