Date:  

 

Purchaser:                                                                           Phone:   

Address:     

                   

Present Owner:                                                                  Phone:    

Address:                

           
Location of Examination:     

 

Persons Present During Examination

Examiner: 

 Buyer/Agent:       

Seller/Agent:   

Person Requesting Exam:   

 

Horse Identification

Name:                                            Breed:                                                       Birth date:    

Sex:                                                Color:                                                        Height:       

History of Surgery/Illness: 

Brands/Markings

            Face:       

            LF:        

            LH:     

            RF:   

            RH:        

 

Current Use:        

 Planned Use:          

Body Condition:    

Temperament:      

Head

Mouth/Teeth:       

Ears:              

Nostrils:         

Larynx:     

Jaw:            

 

Cardiovascular Respiratory System

Heart Rate Pre-exercise:                                                       Resp Rate Pre-exercise:        

Heart Auscultation:                                                             Lung auscultation:        

Temperature:       ºF

CRT/Mucous Membranes:                              

Pulses:       

Jugular  :              

Trachea (Cough elicited?):            

Heart Rate Post-exercise:                                                   Resp Rate Post-exercise:     

Lung Auscultation Post-exercise:      

Gastrointestinal System

            Auscultation:         

Vaccination Schedule:   

Deworming  Schedule: