Medical Boarding Form Your Name * First Name Last Name Phone * (###) ### #### Emergency Contact * Who can we call if your pet needs to be picked up in the case of an emergency First Name Last Name Phone - Emergency Contact * (###) ### #### Pets Information Dog Name Breed Care Instructions Current Diet Amount Per Feeding 1 cup Frequency of Feedings 3x/day Diagnosed Medical Condition(s) Is your pet on any medications or supplements Yes No If yes, Please List all medications below in addition to instructions Phenobarbital 16.2mg every 12 hours - Next Dose due at 8pm Does your pet have any food allergies? Any important information I should know? Training What Cues/Behaviors/Skills does your pet know Does your dog eat things they shouldn't? * No Clothes Toys Food Items Environmental Items Does your dog resource guard anything? * Currently or in the past No Clothes Toys Food Items Environmental Items Date of drop off MM DD YYYY Intended Drop off time Hour Minute Second AM PM Date of pick up MM DD YYYY Intended pickup time Hour Minute Second AM PM Veterinary Info Name of current Veterinary Hospital * Preferred Hospital for Emergencies If there is somewhere specific you would like me to take them in the case of an emergency Does It Just Clicks LLC have permission to approve medical care in the case of an emergency Please inform your primary veterinarian of this permission. It Just Clicks is not responsible for veterinary bills and you will be contacted by the veterinary clinic for billing Yes No Thank you!