Report An Animal Bite Form

Type of bite

laceration

mauling

multiple

puncture

scratch

severe

Time of bite

Hour

:

Minutes

Owner's phone number

Area CodePhone Number

Owner's driver license number and state issued

Owner's email address

If 'Other', please specify

Sex of animal

Color of animal

Size of animal

Is the animal current on a rabies vaccine?

Yes

No

Maybe

Address where the bite took place.

Victim's phone number

Area CodePhone Number

Victim's date of birth

Month

-

Day

-

Year

Guardian's first and last name (if victim is under the age of 18)

First Name
Last Name

Guardian's address (if victim is under the age of 18)

Guardian's email address (if victim is under the age of 18)

Date the victim received treatment

Month

-

Day

-

Year

Report an Animal Bite