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Animal Bite Reporting Form

Today's Date*

Person Reporting*

Phone*

--

Email*

Relationship to Victim*

Victim Name*

Date of Birth*

Phone*

--

Date Bite Occurred*

Location of Incident*

Type of Animal (please give as much detail as possible)*

To your knowledge, was the animal wild or domesticated?*

Wild
Domesticated

Current Status of Animal (choose all that apply)*

Please describe the incident/how the bite occurred.*

Please describe the wound and any treatment received.*

Additional Comments