Skip to main content

Mammal Bite Report

All fields with an * must be completed

Date of Bite: *

Date Report Received

Reported By:

Animal Owner (or location where bite occurred if owner unknown):

Owner Address:

Address Line 1

City

State

Zip Code

Owner Telephone #:

Person Bitten: *

First

Last

Age:

Address

Address Line 1

City

State

Zip Code

Phone

Parent (if victim is a minor):

Location of bite on the body:

Hospital / Physician where treated:

Daytime Telephone #:

Type of Treatment Administered:

Type of Animal (dog, cat, other): *

Breed:

Animal Description / Color:

Layout

Animal Name:

Male or Female:

Male
Female

Place where animal is confined:

Veterinarian:

Layout

Veterinarian Telephone #:

Date of last Rabies Immunization:

Rabies Test Conducted:

Yes
No

Rabies Results:

Positive
Negative

Describe how bite occurred: *