Animal Bite Report

Date of Bite

Time Bite Occurred

Victim Information

Name

Sex

Address

City

State

Postal code

Phone

Alternate Phone

Age

Person completing form

Name

Relationship to victim (if not same person)

Witness Information

Name

Phone

Circumstances of the attack

Type of Injury

Treated for injury?

Where on the body were you bit?

Place of treatment

Date of treatment

Was it a stray animal?

Owner's Information

Name

Address

City

State

Postal code

Phone

Alternate Number

Provide the address and/or vicinity where bite occured

Breed and Color

Sex

Size

Coat

Ears

Tail

Current License/Dog Tag Number

Animal Name

Current Rabies Vaccination

Please provide us with a brief description of the incident.