LA County Department of Public Health - Animal Bite

Department of Public Health

Translate

A-Z Index

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z ALL

Font Size | A A A

LA County

Veterinary Public Health

Home

Animal Bite Report Form (* Required Fields)

Person Reporting Information
* First Name:	* Last Name:
* Phone: 555-555-5555	Are you the victim? Yes No Relationship to Victim:
Email:

Victim's Information
* First Name:	* Last Name:
* Victim's DOB: MM/DD/YYYY	Age:
* Victim's Address:
* City: Add New City Here:
* State: * Zip: * Phone: 555-555-5555
Location of Wound:

Bite Information
* Date of Bite:	Time of Bite: : HH:MM AM PM
Where Bite Occurred: (Sidewalk, Friend's House, etc...)
Nearest Address or Cross Street Where Bite Occurred:
City: State: Zip:
Describe How the Bite Occurred:

Victim's Treatment Information
Treatment Description:
Treated by: (if known) Physician or Facility Name:	Date of Treatment:
Phone: 555-555-5555

Animal Information
* Animal Type: (dog ,cat ,etc...)	Breed: (pitbull, shepard, etc...)
Sex:	Animal's Name:

Animal Owner's Information (if known)

First Name:

Last Name:

Address:

City: State: Zip:

Phone: 555-555-5555

Please provide us with any additional comments

*Code:	What's this? \| (Refresh)

Call 2-1-1 for guidance to LA County health & human services programs.

Register to Vote

Email: Webmaster |

Notice of Privacy Practices |

Website Privacy Policy |

Accessibility |


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.