Animal Bite Report

Animal Bite ReportScott Monheimer2023-09-14T10:37:00-04:00

Information on Person Bitten

First Name

Last Name

Date of Birth

Phone Number

Street Address

City

State

Zip Code

Parent/Guardian Name (if person is a child)

Incident Information

Location of Incident

City

Zip Code

Circumstances of Bite

Date of Bite

Time of Bite

Wound Location

Treated By

Medical Treatment Provided?

Reported By

Phone Number of Individual Reporting

Information on Animal and Owner

Ownership Status

Type of Animal

Animal's Name

Breed

Colors

Sex

Age

Expiration Date of Rabies Vaccination

State in which given

Tag #

Comments

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