Microchip Registration Form

A microchip has a unique identification number that links to your contact information, and can be scanned by any vet clinic or shelter if someone finds your pet. It can help your pet get back home to you if they ever get lost or stolen, escape, or go missing during an emergency like a car accident or fire. The price includes the microchip (about the size of a grain of rice), implantation between your pet's shoulders, and initial registration. This is a one-time cost, and a microchip lasts for your pet's entire life.

Please complete this form if your pet is having a microchip implanted today, with the Owner and Emergency contact details you would like linked to your pet’s microchip.

Which practice would you like to register with?

Location

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PET INFORMATION

Pet's Name *

Species *

Dog
Cat

Sex *

Female
Male

Colour *

Breed *

Birth Date (or estimate) *

DATE OF YOUR PET'S MICROCHIP APPOINTMENT *

OWNER CONTACT DETAILS

If your contact information will change soon or changes often, we suggest using a trusted family member's contact information instead.

If you ever move, change your phone number or change your email you MUST update your pet's microchip information at 24PetWatch.com or there will be no way to contact you if somebody finds your pet.

Full Name*

Address*

City*

Postal Code

Email Address*

Home Phone*

(enter None if not applicable)

Cell/Secondary Phone*

(enter None if not applicable)

Business Phone*

Put your extension (if any) in brackets. (enter None if Business Phone is not applicable)

EMERGENCY CONTACT INFORMATION

In this and the following questions, please enter the contact info for an emergency contact in the event you can not be reached.

***Choose an emergency contact who is unlikely to travel with you and whose contact information is unlikely to change over your pet's lifetime.

Unfortunately as the years pass some owners forget to update their contact information and we have had lost senior pets brought in, only to discover that all of the phone numbers on their microchip have been reassigned or are out of service. A good guideline is to think of an emergency contact whose phone number will likely NOT have changed if yours has become out of date many years in the future.

Full Name (emergency contact)*

Home Phone (emergency contact)*

(enter None if not applicable)

Cell/Secondary Phone (emergency contact)*

(enter None if not applicable)

Business Phone (emergency contact)*

Put extension (if any) in brackets. (enter None if Business Phone is not applicable)

Do you consent to the release of your name and telephone number to anyone that finds your pet?*

Yes (Strongly Recommended)
No, I only want 24PetWatch to communicate with me

Owner Consent*

In order to receive your microchip registration and to be notified if your pet is found, you MUST consent (click Yes) to the consent statement below.

Consent Statement: With your 24PetWatch microchip, we offer you free lost pet services, as well as exclusive offers, promotions and the latest information from 24PetWatch regarding microchip and insurance services. Pethealth Services (USA) Inc., Pethealth Services Inc, PTZ Insurance Services Ltd. and PTZ Insurance Agency Ltd may contact you via commercial electronic messages, automatic telephone dialing systems, pre-recorded/automated messages or text messages at the telephone number provided above, including your mobile number. These calls or emails are not a condition of the purchase of any goods or services. You understand that if you choose not to provide your consent, you will not receive electronic enrollment notification regarding the trial/gift/voucher of insurance and/or free lost pet services which includes being contacted with information in the event that your pet goes missing. You may withdraw your consent at any time.

Yes, I Consent (REQUIRED)
No, I do not Consent

IMPORTANT (PLEASE READ)

Once we have registered your pet’s microchip, only you can make future changes. We recommend that you create an online account at 24PetWatch.com as soon as you receive the microchip details today, so that you can quickly make any changes or report your pet missing in future.

You may receive offers from 24PetWatch for pet insurance and enhanced/phone support subscriptions. Ongoing subscriptions are NOT required – while there is a charge for phone support, you can always update your microchip contact information or report your pet lost through 24PetWatch.com at no extra charge.

Security Question*

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY **

Microchip Registration Form

Which practice would you like to register with?

PET INFORMATION

OWNER CONTACT DETAILS

EMERGENCY CONTACT INFORMATION

IMPORTANT (PLEASE READ)

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