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Animal Bite Report
Animal Bite Report
Scott Monheimer
2024-05-07T07:19:35-04:00
Saratoga County Department of Health
Animal Bite/Incident Report
Email
SECTION I
Report Source (hospital, MD, ACO, Vet office, etc):
*
Report Source Phone
*
Report Date
*
SECTION II: VICTIM INFORMATION
Date of Bite
*
Victim Name
*
Date of Birth
*
County of Residence
*
Victim Address
*
City
*
State
*
Zip Code
*
Parent/Guardian Name (if victim is under 18)
Victim Phone
*
Victim Email
Type of Animal Involved
*
Type of Incident (Bite. Exposure, Other)
*
Is owner known to the bite victim?
*
Yes
No
Unknown
Did the Victim get Medical Attention?
*
Yes
No
SECTION III: ANIMAL OWNER INFORMATION
Owner Name
County of Residence
Owner Phone
Owner Email
Street Address
City
State
Zip Code
Please submit additional notes regarding the incident
SECTION IV: RABIES VACCINATION / ANIMAL CONTROL INFORMATION
Animal Name
Age
Animal Description
*
Vaccination Date
Veterinarian Name
Veterinarian Phone
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