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Service Agreement
Buyer's - Pre-Purchase
Radiograph Interpretation Form
Seller's Statement for PPE
Conflict of Interest Form
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Seller's Statement

First name*

Last name*

Email*

Phone*

Address*

Relationship to owner of the horse at the time of the sale*

Registered name of horse to be purchased*

Barn name of horse:*

Age of horse*

Breed*

Color *

Sex*

Gelding

Mare

Stallion

Microchip Number (if applicable)

Duration of ownership of horse, if less than a year please answer next question*

Who was the previous owner, include phone number

Will you be present for the exam?*

Yes

No

If not, who will be and what is their position?

I hereby grant (name below) to act as my Agent regarding all aspects of the Pre-Purchase Examination of the horse named on this form.*

Past use of the horse*

Intended use of the horse?*

Date of exam*

Current competition level

Eastern/Western Encephalitis

Tetanus

West Nile Virus

Rabies

EHV 4/1, Flu/Rhino

Has Insurance Coverage ever been denied:*

Yes

No

If you answered yes above, please explain

Behavior problems*

Yes

No

List behavior problem

Medical episodes and treatment history:*

Please list dates and descriptions of any and all joint therapies performed.*

Lameness Episodes:*

Reproductive history:

Does this horse require corrective shoeing?*

Yes

No

Name of Horse's Veterinarian*

Short answer

Has this horse been administered any medication in the last 7 days?*

Yes

No

If you answered yes to the question above, please list medication(s) and reason(s) as well as date of last administration.

Has this horse had Extracorporeal Therapy (shockwave therapy) in the last 7 days?*

Yes

No

If yes, please list area:

The Pre-Purchase Examination will include physical examination; it may also include diagnostic and ancillary services recommended by our veterinarians and approved by the prospective buyer or designated agent of the prospective buyer.

I consent to the release of all medical records pertaining to the horse named on this documentto the pprospective buyer and Bur Oak Veterinary & Podiatry Services, such records include those records available from any veterinarian and farriers of record. Please notify them of this request.

Please have them emailed to info@buroakveterinary.com including digital imaging and all records.

I hereby release Bur Oak Veterinary & Podiatry Services LLC and principals of Bur Oak Veterinary & Podiatry Services from any consequences of the Pre-Purchase examination to any humans, animals or property.

I am 18 years of age or older and have the authority to execute this document. To the best of my knowledge, the information I provided on this document is true.

Full name:*

Date picker*

Please upload medical records:

2025 Bur Oak Sports Medicine & Lameness

Website Designed by Cappy Dryden

859-396-2159

3792 DUELLANT RD

LOXAHATCHEE, FL 33470

info@buroakveterinary.com

859-396-2159

2830 OLD LEMONS MILL ROAD

LEXINGTON, KY 40511

info@buroakveterinary.com

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