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Dr Duncan HoustonDr Duncan HoustonWritten by a practising veterinarian

Microchip Implant Certificate

A free fillable microchip implantation certificate for veterinary use. Record the chip, certify the implant, sign on screen, then print or save as a PDF. Patient and owner details are never stored or sent anywhere.

Clinic

Clinic Details

Owner

Owner's Details

Animal

Animal's Details

Microchip

Microchip Details

(15 digits)

(optional)

Implanting a microchip does not register it. The microchip must be registered with a licensed registry, and the owner's contact details kept up to date, for the animal to be identifiable if lost. A microchip with outdated contact details cannot reunite you with your animal.

Certification

Implanter Certification

I certify that I implanted the microchip with the number recorded above into the animal described on this form on the date shown, and that I scanned the microchip after implantation and confirmed that it reads correctly.

Implanter signature

Clinic stamp (stamp the printed copy)

Preview

Microchip Implant Certificate

Live preview · prints exactly like this

Microchip Implant Certificate

Owner's Details

First name
Last name
Address
Phone
Email

Animal's Details

Name
DOB (age)
Gender
Species
Breed
Colour
Markings

Microchip Details

Microchip number
Chip brand / type
Date of implantation
Implant site
Registry the microchip is listed with / to be listed with
Notes

Implanting a microchip does not register it. The microchip must be registered with a licensed registry, and the owner's contact details kept up to date, for the animal to be identifiable if lost. A microchip with outdated contact details cannot reunite you with your animal.

Implanter Certification

I certify that I implanted the microchip with the number recorded above into the animal described on this form on the date shown, and that I scanned the microchip after implantation and confirmed that it reads correctly.

Implanter name
Role
Registration / implanter number
Date signed

Implanter signature

Clinic stamp
Built by Dr Duncan Houston for Ask A Vet · askavet.com

Nothing typed into this form is sent to or stored by askavet.com. All data stays in your browser and leaves only in the PDF or printout you create. Microchipping and registration rules differ by state and country, including who may implant. Check your local requirements before use.

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All 29 certificates and forms
Dr Duncan Houston
About the author

Dr Duncan Houston · BVSc, Veterinarian

Emergency careGeneral practiceMobile vet careFounder, ASK A VET™

Dr Duncan Houston is an Australian veterinarian with experience in emergency, general-practice and mobile veterinary care. He is the founder of ASK A VET™. This guide is educational and is not a substitute for hands-on veterinary care.

When Remember is on, this page saves your clinic's details in this browser only. Owner and patient details are never saved. It is never sent to Ask A Vet. Use Forget to remove them from this computer.