Pre-Purchase Examination Form

Payment Terms: Pre-Purchase Examinations cannot be scheduled until Mulligan Mobile Veterinary Services has your credit card information and authorization.

Please call our office with that information at 250 371-1658

Purchaser

First Name

Last Name

Address

City

Province

Postal Code

Phone Number

Another Representative

Date of Exam

Time of Exam

Horse's Registered Name

Horse's Barn Name

Colour

Gender

Age

Breed

Intended Use

Have you Ridden This Horse?

History

Purchaser's Trainer

Trainer's Phone Number

Will you be present for the pre-purchase exam?

I consent to the seller being present for the exam

I grant permission to share the information from the prepurchase exam with the seller

Purchasers Regular Veterinarian

Requested Procedures: please select all that apply

Basic Pre-purchase Exam Complete Blood Count Chemistry Profile Standard Coggins Test Drug Screen Full Oral Exam Using Sedation Broodmare Examination ( Culture, Ultrasound, Palpation)

Comments

Imaging

None Both Front Feet Both Knees Both Hocks Both Stifles Both Front Fetlocks Both Hind Fetlocks X-rays only if Warranted at time of Exam Other

Please describe any specific concerns you would like addressed in this Pre-Purchase Exam

Convenient, Caring and Personal Veterinary Service
offered at your farm

Contact Me

Cell: (250) 371-1658
Office: (250) 371-7409
[email protected]

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hours of operation

Monday - Friday:
8:00AM - 5:00PM
Saturday - Sunday:
By appointment Only