Prepurchase Exam Request Please enable JavaScript in your browser to complete this form.Purchaser Name *FirstLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Seller InformationSeller Name *FirstLastSeller Phone *Horse InformationHorse Name *Location of Horse *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIntended Use of Horse *Please describe any specific concerns you would like addressed during the examServices RequestedPrepurchase ExamRadiographsCogginsHealth CertificateRadiographs RequestedFront FeetKneesHocksStiflesFront FetlocksHind FetlocksOtherDo you have any prior medicals records for this horse?YesNoPlease upload prior records here. Click or drag files to this area to upload. You can upload up to 5 files. Coggins InformationHorse Name *This is the name that will appear on the official coggins formBreed *Color *Date of Birth *GenderMareStallionGeldingTerms *I understand that I am responsible for the payment of the above procedures at the time of service.I authorize Hoerr Veterinary Service to charge my credit card for the total amount due at the conclusion of the exam.I understand that this exam will not be scheduled until Hoerr Veterinary Service has received my credit card information.Submit
