Department of Public Health
   
Animal Bite Report Form (* Required Fields)

Person Reporting Information
* *
* 555-555-5555 Are you the victim?
 
Victim's Information
* *
* mm/dd/yyyy
*
*  
*      *     * 555-555-5555

Location of Bite (check all that apply):
        
        
     

Which side of the body is bite located?   
 
Bite Information
* : HH:MM


         

 
Victim's Treatment Information
Type of treatment (check all that apply):
           
        
Treated by: (if known)



555-555-5555
 
Animal Information
*
S
 
Animal Owner's Information (if known)

         
555-555-5555


  


 
Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
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