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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)*
Owned/In Possession of Victim
Owned/In Possession of Other
Stray/Feral
Location Unknown
In Possession of Animal Control
Euthanized
Quarantined
Awaiting Testing
Please describe the incident/how the bite occurred.*
Please describe the wound and any treatment received.*
Additional Comments