Rogue Equine & Companion Animal Clinic

for compassionate, personalized, expert veterinary medical care
serving Southern Oregon and Northern California.

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Buyer Disclosure Form

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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.

  • Section Break

    Your agent or representative must be available during the times to contact otherwise attempts to contact with no answer will delay the exam and potentially increase exam cost.
  • Section Break

  • Please list basics, with notes on markings if you know them. For example, Bay with star, right front pastern white. Please note brands if present.
  • MM slash DD slash YYYY
  • Please note or list all intended uses of the horse standing for the purchase exam, in order of importance.
  • Please note special circumstances, requests, concerns or any issue you wish to convey regarding the horse, the exam or circumstances. Please type "NONE" if you have no comment or concerns.
    Please tick the box for each item of interest. This is NOT a commitment or contract for services, but an indication for us to discuss those items with you in more detail.
    Please tick the box for each area of interest for imaging. This is NOT a commitment or contract for services, but an indication for us to discuss in more detail. Cost is up to 60.00 per image plus 57.00 PACS/Archiving Fee and 50.00 sedation fee. Ultrasonography is approximately 280.00 per site plus 50.00 sedation fee.
    Third party, or referral of images to an outside part will take place - unless declined. Additional cost is based on number of images, regions included and reviewer selected. Fees range from $300 to $700.
  • This purchase examination provides information about the horse’s health and condition at the time of the examination. It is the buyer’s responsibility to inform the veterinarian of the extent of examination and the selection of any diagnostic tests chosen. The examination is not to be used as a prognosis for future use, and findings are not a warranty, express or implied, of future health, soundness or suitability. The veterinarian’s role in the examination is not to pass or fail the horse, but to help the prospective buyer make an informed decision considering the horse’s overall health and soundness at the time of the examination. The decision on whether or not to purchase the horse examined is solely the buyer’s choice and responsibility.
    The buyer should understand that there are limitations to a purchase examination, and certain conditions may not be detectable by clinical, radiographic, ultrasonographic and/or laboratory examinations on the day of the examination. The buyer acknowledges that the veterinarian is not liable for conditions that may present in the future that could affect performance or resale, and this agreement is to release, waive, discharge and dismiss Rogue Equine Hospital and all employees from any claims arising directly or indirectly from the performance of the purchase examination. The information and findings from today’s exam may be shared with the current owner/agent of the horse.
    All fees/charges are to be paid in full at conclusion of the exam. Final laboratory fees may not be determined until after the exam is complete. Any dispute with fees and charges will be settled in Jackson County, Oregon.
  • In the event of a scheduled and confirmed appointment being cancelled for ANY REASON within 24 hours of the scheduled appointment, a cancellation fee may apply. Cancellation Fee within 12 hours, or same day is $250.00, cancellation notification 12-24 hours is $100.00.
  • A credit card is required to be on file, and a hold will be placed for the estimated trip (if applicable) and exam fee upon booking. A cancellation fee (see above) will apply toward services rendered relative to a purchase exam. A final cost will be provided at conclusion of the exam and your card will be charged for the balance unless other arrangements have been made. Your agreement for the hold and cancellation fee or final balance to charged to the provided card is required to hold a scheduled appointment dedicated to your service request. Please call our office after completing this form to process your card as a HOLD, or you may follow the directions following this for to process the charge online.
  • Clear Signature
    This form must be completed and signed by the person ordering the purchase examination and who is financially responsible for this service.
  • This field is for validation purposes and should be left unchanged.
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