Microchipping Service Registration Form

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Microchipping Service Registration Form

Please register your pet to receive a free microchip. Please contact Robin Flieg at rlflieg@dekalbcountyga.gov or 404-371-4749 with any questions or concerns.

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* Indicates required question

Email *

Your email

Your First Name *

Your answer

Your Last Name *

Your answer

Pet's Name *

Your answer

Pet's Species *

Dog

Cat

Pet's Approx. Weight *

Your answer

Has this pet been spayed or neutered? *

Yes

No

Not sure

House number and street (include Apartment Number if applicable) *

Your answer

City *

Your answer

State *

Your answer

Zip Code *

Your answer

Phone Number *

Your answer

How did you hear about this event?

Your answer

Send me a copy of my responses.

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