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PRE-PURCHASE EXAMINATION

CUSTOMER: DATE:

HORSE: SEX:

PEDIGREE: DATE OF BIRTH:

BREED: SELLER:

COLOR: AGENT:

PASSPORT NUMBER: MICROCHIP NUMBER:

FEI PASSPORT NUMBER:

Attached Documents:

❏ Examination Protocol ❏ Endoscopic Images on CD/USB

❏ Radiographic Images on CD/USB ❏

Ultrasound Images on CD/USB

❏ ______________________ ❏ Video Recording on CD/USB

Tierklinik L üsche GmbH

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A. CONTRACT CONDITIONS § 1 (customer) commissions the veterinarians of the

Equine Clinic Lüsche (contractor) with the examination of the horse: The extent

of the examination is determined by the customer and specified in §10 chapter 1, chapter 2, and § 12

of this document. No examinations that have not been specified and initialed within this protocol will

be included in this pre-purchase examination. The content of the examination can only be amended

by written agreement.

§ 2 The examination serves as evaluation of the horse’s health status at the time of examination. The

examination does not constitute a declaration of defects in the legal sense. Stereotypies like weaving

or crib biting, management dependent recurring airway disease, allergies, and certain diseases of the

upper airway tract that can only be diagnosed after intense exercise cannot be assessed. The pre-

purchase examination does not include assessment of these disorders. The examination will also not

give an estimation of breeding values or a prognosis on the breeding or athletic career of the horse.

§ 3 The veterinarian is not obliged to explain the risks of all individual steps of the examination, as long

as the extent of the examination does not differ from the description in this document. The customer

agrees to all procedures that need to be performed during the examination. The customer guarantees

that the owner of the horse also agrees to these.

§ 4 It is understood and agreed that the results of the examination may be discussed with the

vendor/owner and purchaser of the horse but not with any third party. However, the customer may at

his or her discretion not allow disclosure to any other party including the vendor/owner. The

information included in this examination protocol is solely intended for the customer. The veterinarian

needs to give his or her consent if this document is to be distributed to any third party.

§ 5 The evaluation of the obtained findings (Part C of the examination) is done with the greatest

possible care of the veterinarian and reflects his or her opinion. A prediction about the future

development of the health status, performance and use cannot be given, because the horse is a living

animal that is subject to constant changes in constitution and condition. Only the customer can make

a decision on the purchase.

§ 6 Costs for the standard clinical examination (excluding imaging etc.) are based on the purchase

price of the horse, obtained from the customer personally. If the horse’s price is less than € 5.000,-

the cost is € 250,- excl. VAT. If the horse’s price is more than € 5.000,-, the price of the clinical

exam increases by 0,6 % of the purchase price. The customer understands that increased liability

coverage is possible and will result in increased fees depending on the coverage selected. It is not

possible to change the purchase price of the horse, once the examination has begun.

The customer or authorized person hereby personally confirms and is bound to the purchase price of the horse

mentioned above and presented for examination.

§ 7 The contractor is liable for an amount that is not higher than that of the purchase price/value of the

horse. The same liability cover applies to any person authorized in the contract. Third party liability is

excluded.

§ 8 Unless there are individually negotiated terms about the limitation period, the statute of limitation

is one year. This means that legal proceedings can only be initiated by the customer or other

authorized person who is mentioned within the contract, within the period of one year, which starts

with the initiation of the statue of limitations.The statutory period ends 5 years after the date of

examination. § 9 The location of examination is independent of the agreed conditions and process of

examination in this contract. Even for examinations outside Germany, the German legal court is the

only court that is authorized to assess the conditions of this contract. This also applies to third party

claims.

€ Read and accepted , Signature

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§ 10 Definition of Examination

Prices in €

without

VAT Confirmation Signature

Clinical examination following the attached protocol BJ.-B.IV. The

examination price consists of a basic fee of € 250,00 plus 0,60 % of the

purchase price/value if the value of the horse is more than € 5.000.

In case the customer terminates the pre-purchase examination during

the clinical examination, only the basic fee of € 250,00 will be charged.

Examination under tack

250,00 € plus 0,6 % of the purchase price/value

100,00 €

❏

❏

“Doping Examination”, blood examination for foreign substances

Collect b lood sample and store for a six-month period (in house).

❏ Testing for NSAIDs, corticosteroids and sedatives

❏ FEI testing kit for shipping

❏ Express service

❏ Storage by an external laboratory

Examination for anabolics (can only be carried out by

special request and on urine or hair samples)

free

200,00 €

32,50 €

120,00 €

41,00 €

❏

Standardized German protocol of the radiological examination, 18 radiographs lateromedial views of all four distal limbs, upright pedal

view (dorso 45°proximal-palmarodistal oblique) of each front foot, three

views of each hock ( 0°, 45° & 135°) and 2 views of each stifle ( 90° and 0°)

18 x 24,23 € =

436,14 €

❏

Skyline-Image of the navicular bone

Special view of the navicular bone from proximal to distal. The radiograph shows the distal border of the navicular bone. There are occasions when the navicular bone looks fine on the upright pedal view (“oxspring”), but one can clearly see changes in the navicular bone on the skyline view.

❏ left front ❏right front 24,23 € per

image ❏

Fetlocks/sesamoid bones in oblique Visualization

Visualization of the articular surface and of the sesamoid bones in

diagonal visualization; more information on the articular surface,

condition of the sesamoid bones, possible “chips”/ isolated opacities 24,23 € per

image ❏

❏ left front ❏right front

❏ left hind ❏right hind

Fetlocks/sesamoid

Visualization of the joint space an bones

❏ left front

bones in AP/ Front to Back - Visualization

d the lateral borders of the involved

❏right front 24,23 € per

image ❏

❏ left hind ❏right hind

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Back: Thoracic Spine/ Lumbar region/ Dorsal spinal processes

Visualization of the dorsal processes from the withers to the lumbar

vertebrae. In most cases, radiographs of high quality can be obtained. In

horses that are very muscular or have a large amount of adipose tissue the visualization of the dorsal processes can be limited. The intervals

between the dorsal processes and potentially chronic changes can be visualized. 24,23 € per

image

❏

Cervical Spine

Visualization of the cervical spine 24,23 € per

image

Additional radiographs: _____________________________ 24,23 € per

image

❏

Chiropractic/ biomechanical evaluation

150,00 €

❏

Evaluation of referral radiographs in written form 10,00 € per

image

❏

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§ 10 Definition of Examination

Prices in

€

without

VAT

Confirmation Signature

Export Screening (Laboratory Dr. Böse)

Country of destination: ____________________________ Price upon

request ❏

Laboratory Examination

❏ Complete blood count, serum chemistry

❏ Fecal examination for parasites (McMaster-method)

❏ Further examinations: __________________________________

78,30 €

18,78 €

❏ Andrological examination (incl. semen collection and evaluation)

207,24 € ❏

Reproductive examination of mares incl. ultrasound examination 42,11 € ❏

Endoscopic examination of the larynx and the upper airways

Access via the nostrils and visualization of the pharynx, larynx, trachea,

bifurcation of the lungs and evaluation of the main bronchi.

105,71 €

❏

Additional examination of the respiratory system

Blood gas analysis

31,18 € ❏

Additional eye examination

❏ Ultrasound

❏ Slit lamp

57,50 €

49,31 € ❏

❏ Tonometry (measurement of intraocular pressure)

❏ Fluorescent dye test (per eye)

33,19 €

7,05 €

Rectal examination

Examination of the pelvic and abdominal organs

34,56 € ❏ Cardiac ultrasound with “Sonodoppler“ (+ time fee) 327,34 €

❏ Ultrasound examination

❏ Tendons (per leg)

❏ Cervical spine

86,82 €

138,20 € ❏

❏ Back 135,49 €

❏ Sacroiliac joint 135,49 €

Video recording in house

(excl. if price of the horse is below € 5000, incl. if price is above € 5000)

80,00 €

❏

Qualisys “Q-HORSE“ Objective gait monitoring

120,00 € ❏

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The customer or the authorized person herewith confirms the requested services described above.

The payment, in cash or EC cash, is due directly after performing the examination.

Additional examinations will be charged according to the GOT (charging settlement by german law).

§ 11 The customer is obliged to pay for the radiographs and the assessment of the radiographs he

or she has requested and signed for on this form. These radiographs are the property of the

contractor. The customer is not obliged to release them. Copies can be obtained on request,

additional costs will incur. Evaluation of other, previously taken images (radiographs, ultrasound

images etc.) is only possible when the veterinarian who was responsible for these has assessed

and reported them in written form.

§ 12 Special agreements/ requests for the pre-purchase examination:

§ 13 Should any clause in this contract be partially or entirely ineffective, the contract as a whole

will not be affected. The examination report and its contents are subject to the laws of the Federal

Republic of Germany with the exception of any conflicting standards where applicable. The German

and the English texts of the examination report shall be equal. In the event of any inconsistency

between the German and the English text, the German text shall prevail and is legally binding.

City Date

Customer Contractor

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B. HISTORY OF THE HORSE B. 1. Detailed history of the horse as supplied by the vendor or authorized person

Name:

Address:

Telephone/Email:

Persons present:

Period of ownership: ___________________________________________________

Previous pre-purchase examination: ❏ yes ❏ no ❏ not known ❏ Date: _________________

Result:

Current training level of the horse:

Intended purpose: ____________________________________________________________

Medication in the last 6 weeks: ❏ yes ❏ no

Medication:

Indication and dosage: Time of usage: ________

Previous lamenesses:

Previous diseases:

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Surgeries: Castration

Stereotypies (Weaving, crib biting, etc.):

Housing: ❏ Stable ❏Pasture ❏Open stable ❏ Stable & Pasture

Feeding: ❏ Hay ❏dry ❏wet ❏ Silage

❏ Oats ❏Pellets ❏Other:

Bedding: ❏Straw ❏Shavings ❏Other:

Last date of shoeing: Last date of deworming:

Last dental examination:

Vaccinations: ❏Influenza ❏Herpes

❏Tetanus ❏Other:

Passport: ❏present FEI-Passport: ❏present

Medical adnex:❏present ❏Intended for human consumption ❏Not intended for human consumption

I guarantee that the information provided about the horse in this form is correct. I agree with all

procedures of the pre-purchase examination, which include blood withdrawal for substance testing,

sedation during endoscopic examination and removal of the shoes for the radiographs of the navicular

bone.

During the pre-purchase examination I will be present/ not be present* *cross

out whichever does not apply

As the current owner or authorized person, I also declare that:

❏The Equine Clinic Lüsche was not involved with pre-treatment of the horse.

❏A veterinarian of the Equine Clinic Lüsche did treat the horse prior to the pre-purchase examination. The

Equine Clinic Lüsche is hereby released from the professional code of conduct for veterinarians.

Mr/ Mrs from is authorized to represent me and sign my documents during the examination

Signed by: ❏Owner ❏ Vendor ❏Authorized person

Signature

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B. 2. PRESENT PERSONS DURING EXAMINATION:

❏Buyer ❏Vendor ❏ Third person

B. 3. PLACE AND DATE OF EXAMINATION:

Lüsche, (date) or , (date)

B. 4. PRELIMINARY INFORMATION STATED BY THE PURCHASER OR AUTHORIZED PERSON:

Did the purchaser test the horse prior to the examination: ❏

yes

❏

no

Any rider’s remarks/observations:

❏

yes

❏

no

B. 5. DESCRIPTION OF THE HORSE:

❏ Not necessary if a description of the horse is available in the passport

❏ Identification verified by microchip reader

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❏ No microchip

Description:

C. CLINICAL EXAMINATION C. 1. General Examination

General:

General condition: ❏ WNL (within normal limits)

Skin/ hair and significant scars: ❏ WNL

Grooming condition: ❏ WNL

Mucous membranes: ❏ WNL

Conjunctiva: ❏ WNL

Mandibular lymph nodes: ❏ WNL

Jugular veins: ❏ WNL

T emperatur e : ° C

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Heart auscultation:

❏ WNL

Frequency:_____/min Quality:________________________ ❏

WNL

Respiratory system:

Rest frequency:___/min

Respiration:

Nasal discharge:

❏ WNL

❏ no

Spontaneous cough: ❏ no

Coughing reflex: ❏ no

Larynx palpation: ❏ WNL

Trachea-auscultation:

❏ WNL

Trachea-palpation: ❏ WNL

Lung-auscultation: ❏ WNL

Eyes:

Right eye: ❏ WNL

Left eye: ❏ WNL

❏ WNL

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Neurological Examination:

Peripheral nervous system:

Mouth:

❏ Incisors, rostral oral cavity: ❏ WNL

❏ without speculum and sedation – could not be performed completely

Feces: ❏ WNL

Exterior reproductive organs:

Palpation & inspection: ❏WNL:

Further Examination:

C. 2. Examination of the locomotory system

Inspection and palpation of the limbs: ❏ WNL

Inspection and palpation of the hoofs: ❏ WNL

Examination with hoof testers: ❏ WNL

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Biomechanical Examination of the top line:

Neck palpation: ______________________________________________❏ WNL

Back palpation: ______________________________________________❏ WNL

Pelvis palpation: _____________________________________________ ❏ WNL

Examination in walking on hard ground:

Straight line: _____________________________________________________________________________

Figure 8:________________________________________________________________________________

Backing up: ______________________________________________________________________________

Examination in trot on hard ground:

Straight line:

Circle left:

Circle right:

Flexion tests:

Flexion test of the limbs:

Active Passive

Left front Distal - +/- + ++ - +/- + ++

proximal - +/- + ++ - +/- + ++

Right front distal - +/- + ++ - +/- + ++

proximal - +/- + ++ - +/- + ++

Left hind distal - +/- + ++ - +/- + ++

proximal - +/- + ++ - +/- + ++

Right hind distal - +/- + ++ - +/- + ++

proximal - +/- + ++ - +/- + ++

Specific flexion tests:

Other:

Examination on soft ground:

Lunged: with draw reins ❏ yes ❏ no

Circle left:

Circle right:

Transitions:

Ridden:

Neurological Examination in movement: ❏ WNL

___________________________________________________

C. 3. Examination of the heart and respiratory system during and after exercise

Exercise until respiratory rate increases:

❏ lunged ❏ ridden

1. Abnormal

respiratory

noise:

❏

inspiratory

❏exspiratory ❏

yes

❏ no

2.

Respiratory

problems:

❏

yes

❏ no

3.

Coughing,

nasal

discharge:

❏

yes

❏no

4. Heart and respiratory rates:

Before exercise After exercise Recovery time

Heart rate

Respiration rate

C. 4. Radiological examination:

Referral images: veterinarian / date:

Standard projections ( according to the German radiological guidelines of 2018) Radiographs, which do not show any divergence from the normal radiological anatomy, are labeled

with w.n.f. (within normal findings) and they do not need to be refered.

Radiological findings:

A-Radiological findings, by which the risk for a lameness cannot be estimated reliably. B-Radiological findings, which are correlated with a risk of lameness. They are labeled in the list

of findings as risk.

1.

Hoof left front 90° (lateromedial w ith the beam focus on the navicular bone)

2.

Foot left front (lateromedial w ith the beam focus on the fetlock joint)

3.

Foot left hind (lateromedial w ith the beam focus on the fetlock joint)

4.

Hoof right front 90° (lateromedial w ith the beam focus on the navicular bone)

5.

Foot right front (lateromedial w ith the beam focus on the fetlock joint)

6.

Foot right hind (lateromedial w ith the beam focus on the fetlock joint)

7.

Tarsus left hind 0° (dorsoplantar)

8.

Tarsus left hind 45° (DLPMO = dorsolateral-plantaromedial oblique)

9.

Tarsus left hind 135° (DMPLO = dorsomedial-plantarolateral oblique)

10.

Tarsus right hind 0° (dorsoplantar)

11.

Tarsus right hind 45° (DLPMO = dorsolateral-plantaromedial oblique)

12.

Tarsus left hind 135° (DMPLO = dorsomedial-plantarolateral oblique)

13.

Stifle left hind 90° (lateromedial)

14.

Stifle left hind 180° (caudoproximal-craniodistal)

15. Stifle right hind 90 (lateromedial)

16.

Stifle right hind 180 ° (caudoproximal-craniodistal)

17.

Hoof links Oxspring 0° (dorsoproximal-palmarodistal oblique

18. Hoof right Oxspring 0° (dorsoproximal-palmarodistal oblique)

Additional projections

19. Dorsal spinal processes (End of w ithers / saddle area/ lumbar area):

20. Neck spine

21. Skyline projection of the left navicular bone (tangential appearance of the navicular bone)

22. Skyline projection of the right navicular bone (tangential appearance of the navicular bone)

23. Oblique projections of the foot

24. Foot 0° (dorsopalmar)

Other radiographs:

C. 5. Endoscopic examination of the upper airways:

❏ Not performed ❏ WNL ❏ Digital images ❏ Video ❏ Sedation

C. 6. Further examinations (if applicable ultrasound examination of limbs):

C. 7. Doping sample:

❏ Not taken ❏ taken for immediate examination ❏ taken and frozen

(for 6 months; -18°)

❏ Storage in external laboratory

D. ASSESSMENT OF THE EXAMINATION RESULTS We cannot assess sterotypic behaviour!

❏ Preliminary report filled out by vendor

❏ Based on today’s examination, we see no increased risk for the intended use of the

horse

Radiographic examination:

The customer or authorized person confirms acceptance of the terms of the examination contract. The

findings described herein and the implications in terms of use of the horse have been explained. The

undersigned warrant that they have permission of the horse owner to sign for the examination results and

specify purchase price of the horse as in § 6 & § 7 of the contract.

Examining veteriniarian

City D at e, ,

Customer or authorized person