Pre-purchase examinations are among the most consequential — and most litigated — procedures in equine practice. A thorough PPE protects the buyer, establishes your professional credibility, and generates significant revenue. A sloppy one exposes you to liability that can follow you for years.
The challenge for mobile equine vets is that PPEs are time-intensive, logistically complex, and happen in field conditions where shortcuts are tempting. The horse is at the seller's barn, the buyer may or may not be present, the footing might be terrible, and you have three more stops after this one.
A systematic workflow solves this. It ensures you never miss a step, keeps the exam on schedule, and produces documentation that stands up to scrutiny months or years after the sale.
Defining the Scope Before You Arrive
The most common source of PPE disputes is mismatched expectations. The buyer expects a comprehensive five-stage exam. You performed a basic soundness evaluation because nobody specified the scope. The seller is irritated because the exam took twice as long as they anticipated.
Settle the scope before you leave your truck for the appointment:
- Level 1 — Basic soundness exam. Physical examination, lameness evaluation at walk and trot on a straight line and circles, and flexion tests. No imaging. Appropriate for lower-value purchases and situations where the buyer accepts limited screening.
- Level 2 — Standard PPE. Everything in Level 1 plus ridden evaluation (if the horse is in work), ophthalmic examination, and baseline blood draw for storage.
- Level 3 — Comprehensive PPE. Everything in Level 2 plus radiographic series, upper airway endoscopy, and potentially ultrasound evaluation of identified areas of concern.
Document the agreed scope in writing — an email confirmation or a signed pre-exam agreement — before you begin. When the buyer calls six months later asking why you did not radiograph the navicular bones, your signed agreement showing they selected a Level 1 exam is your protection.
Your practice management software should have a PPE agreement template that the buyer signs digitally before the exam begins. This is one of those administrative steps that feels like overhead until the day it saves your practice from a lawsuit.
The Examination Sequence
Consistency matters more than any particular order. What matters is that you follow the same sequence every time, so that completeness becomes automatic rather than dependent on memory.
Here is a sequence that flows logically and minimizes wasted time:
Phase 1: History and Identification (10-15 minutes)
- Verify the horse's identity against registration papers, markings diagram, and microchip (scan and record the number).
- Obtain history from the seller or their representative: age, use history, known health issues, current medications, recent veterinary care, shoeing history, and behavioral notes.
- Photograph the horse from four standard angles (left side, right side, front, rear) for identification documentation.
Phase 2: Static Physical Examination (15-20 minutes)
Work systematically from head to tail:
- Eyes: Direct and consensual pupillary light response, menace response, fluorescein stain if indicated. Use your ophthalmoscope in a darkened area of the barn.
- Oral cavity: Dental examination for age verification, hooks, ramps, wave mouth, missing teeth.
- Cardiopulmonary: Auscultation at rest. Note any murmurs with grade, timing, and point of maximal intensity. Lung sounds in all fields.
- Gastrointestinal: Abdominal auscultation, body condition score.
- Musculoskeletal: Palpation of all four limbs — tendons, ligaments, joints, hooves. Note any heat, swelling, effusion, or asymmetry. Hoof tester evaluation of all four feet.
- Integumentary: Skin, coat condition, scars, brands, evidence of previous surgical sites.
- Neurological: Basic assessment — posture, gait observation, tail and anal tone if indicated.
Phase 3: Dynamic Evaluation (20-30 minutes)
- Walk and trot in hand on a firm, level surface, straight line. Observe from front, side, and behind.
- Circles at trot on firm ground, both directions. Watch for inside-limb lameness.
- Flexion tests: Distal and proximal on all four limbs. Document the flexion time (60 seconds is standard) and grade the response.
- Lunging on soft footing at trot and canter, both directions, if a suitable area is available.
- Ridden evaluation (Level 2 and above): Watch the horse under saddle at walk, trot, canter. Include transitions and lateral work if the horse's training level allows. The ridden evaluation often reveals issues not apparent in hand — back pain, resistance, behavioral indicators of discomfort.
Phase 4: Diagnostics (variable, 30-90 minutes)
- Radiographs: A standard screening series typically includes feet (lateral and 65-degree DP of all four), hocks (four views each), stifles (lateral and caudocranial), and cervical spine (lateral). Adjust based on intended use and findings from the physical exam.
- Blood draw: Minimum two tubes for storage — one for potential drug screening, one for baseline CBC/chemistry if requested. Label with the horse's identification, date, and a unique exam identifier.
- Additional diagnostics as indicated: Upper airway endoscopy, reproductive ultrasound for broodmare purchases, cardiac ultrasound for performance horses with murmurs.
Digital Radiography Workflow in the Field
Radiography is where PPEs most commonly bog down or produce substandard results. Field conditions — uneven footing, inadequate lighting, no lead wall — demand a disciplined workflow.
Setup checklist before you shoot:
- Position the horse on the most level surface available. Bring positioning blocks for foot views.
- Check that your generator is charged and your detector is paired and transmitting.
- Set your exposure charts on the tablet or laptop before starting. Adjusting technique factors between every shot is the primary time sink.
- Designate a holder if needed, and ensure proper radiation safety — thyroid collar, lead apron, gloves for the holder, dosimetry badge if you use them.
Shoot systematically: Start with the feet (horse is standing still and cooperative at the beginning), then move proximally. Hocks, stifles, cervical spine. Label each image in your software as you go — do not batch-label later when you are trying to remember which of forty images is the left hock DLPMO versus the right.
Read on-site. Review every image at the barn before you pack up. It is vastly easier to reshoot a technically inadequate view while the horse is still positioned than to schedule a return trip. Your practice software should display images on a tablet or laptop with sufficient resolution for field interpretation. Detailed review can happen later, but you should confirm diagnostic quality before leaving.
Managing Buyer and Seller Dynamics
PPEs involve inherent tension. The buyer wants transparency. The seller wants the sale to proceed. You are in the middle, and your obligation is to the buyer who hired you — but you are conducting the exam at the seller's facility, often with the seller watching.
Ground rules that reduce friction:
- Communicate your process at the start. Tell both parties what you will do, approximately how long it will take, and when they can expect your findings. Predictability reduces anxiety.
- Do not provide a pass/fail verdict on site. Your role is to document findings, not to advise whether someone should buy the horse. "I identified moderate effusion in both hocks and grade one lameness on the left hind after flexion. I will detail these findings in my report and discuss their significance with the buyer." This is factual, professional, and protects you from the seller accusing you of killing their sale.
- Deliver findings to the buyer privately. Your report and your clinical discussion are for the buyer. The seller is entitled to know what was done to their horse, not to your clinical assessment of its suitability for the buyer's purposes.
- Document seller-provided history verbatim. If the seller states "He has never been lame," record that quote. It establishes the information you were given, which matters if the horse's history proves different.
Report Generation and Record Retention
Your PPE report is a medico-legal document. Treat it accordingly.
The report should include:
- Horse identification (name, breed, age, sex, color, markings, microchip number, registration number)
- Buyer and seller identification
- Date and location of examination
- Scope of examination performed (referencing the level agreed upon)
- Detailed findings organized by body system
- Radiographic findings with image references
- Blood sample disposition (stored, submitted, or both)
- A clear statement that the examination represents findings on the date performed and does not guarantee future soundness
Do not include: A recommendation to buy or not buy the horse. Your job is to present findings. The buyer's decision is their own, informed by your clinical data.
Store the complete record — report, images, consent forms, and correspondence — for a minimum of seven years, ideally longer. PPE disputes have surfaced a decade after the sale. Digital records in a properly backed-up practice management system handle this effortlessly. Paper files in a cabinet handle it until they do not.
Billing for Complex PPEs
PPEs are premium services. Bill accordingly and transparently.
Provide the buyer with a written estimate before the exam, broken down by component: exam fee, radiographic series (by number of views or regions), endoscopy, blood draw and storage, sedation if required, and the report preparation fee. Complex PPEs can easily exceed a thousand dollars, and buyers who understand the breakdown in advance rarely object.
Track your actual time against your estimates over a series of PPEs. If your Level 3 exams consistently take four hours but you are billing for three, your pricing model needs adjustment. Practice management software that tracks time per visit type gives you this data without manual logging.
The Systematic Advantage
A PPE performed with a consistent, documented system takes the same amount of time as one performed haphazardly — often less, because you are not backtracking to cover steps you skipped. The difference is entirely in the quality of the output: a defensible record, a thorough evaluation, and a professional impression that generates referrals.
Build your system. Follow it every time. Your thoroughness is your reputation.