Pre-Purchase Exam Form/Buyer Disclosure Form

This completed form is required by law in order for us to provide service. This information is kept secure, private and will not be shared with any 3rd party without your expressed consent. The call fee is $130.70 and the Pre-Purchase Exam is $608.25. The standard Pre-Purchase Exam includes a full physical exam and a full lameness exam with flexion. All additional procedure prices are listed below. Please note that we are unable to take video the exam on the buyer's behave.

Please mark the box for each item of interest. These additional procedures are NOT a commitment or contract for services, but an indication for us to discuss those items with you in more detail. All additional procedures that are completed will be added to the exam cost. The listed prices are only estimates. The actual price may differ. Prices are subject to change without notice.
Laboratory Testing or Procedures Requested
Please mark the box for each area of interest for imaging. These additional procedures are NOT a commitment or contract for services, but an indication for us to discuss those items in more detail. All additional procedures that are completed will be added to the exam cost. Ultrasonography is dependent on site/region. Radiographs are up to $74.48 per view plus one PACS storage fee of $37.75 plus one Radiograph Equipment Set Up of $180.18 plus one Radiograph Interpretation of $120-$495+ (depending on the number of radiographs taken).The listed prices are only estimates. The actual price may differ. Prices are subject to change without notice.

Example: Each knee is 4 views. Radiographs of the right and left knee would be 8 views total. $74.48 x 8 = $595.85 + $37.75 + $180.18 + $120 = $933.77
Radiography Images Requested
Ultrasonography pricing is depenent on site/region. Please explain site/region requested in the comments section.
Ultrasonography Imaging Requested
Horse’s Medical History
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Statement of age for legally binding engagment
The pre-purchase examination is not a warranty nor a guarantee of soundness or unsoundness. No guarantee is implied by this document nor by verbal comments made by the examiner. A pre-purchase examination is only the opinion of the examiner on the day of examination. A buyer can not protect oneself against all possible medical issues, horses with intermittent issues, horses with subclinical issues, nor horses on medications. All pre-purchase examinations are limited by financial considerations, facilities, time, and temperament of the horse. Conley and Koontz Equine Hospital and/or the examiner only accepts liability up to the price charged for the pre-purchase examination.
A credit card is required to be on file and will be applied toward services rendered relative to the pre- purchase exam. The standard pre-purchase cost will remain the same even if you decide to stop the exam. A final cost will be provided, and your card will be charged for the balance. Your agreement to have the provided card charged for the final balance is required to hold a scheduled appointment dedicated to your service request. Please call our office after completing and emailing this form to [email protected] to process your card.
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