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Animal Services Bite Report 2026
Animal Services Bite Report
Bite Information
Victim`s Treatment Information
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Drag and drop csv file with emails
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Animal Services Bite Report
Person Reporting Information
First Name:
*
Last Name:
*
Clinic/Hospital Name
Phone:
*
Phone
form field Phone:
must be in the format: (000) 000-0000
Email:
*
Email
form field Email:
is not in correct form
Date of Birth:
*
Date
form field Date of Birth:
must be in the format: MM/dd/yyyy
Today's Date
Date
form field Today's Date
must be in the format: MM/dd/yyyy
Address:
*
Are you the victim?
*
Yes
No
Clear
Relationship to Victim:
*
Value is not selected
-- Select one --
Healthcare provider
Other
Pet owner
Shelter/Rescue
Veterinary Hospital/Clinic
Kennel/Peet Fancier
Parent
Friend
Are you the animal owner
*
Yes
No
Clear
Do you have animal owner information:
*
Yes
No
I have the information, but will not provide it
Clear
Is the bite victim a minor?
*
Yes
No
Clear
Victim's Information
First Name:
*
Last Name:
*
Victim's Date of Birth:
*
Date
form field Victim's Date of Birth:
must be in the format: MM/dd/yyyy
Victim's Address:
*
Victim Email:
Email
form field Victim Email:
is not in correct form
555-555-5555
Phone:
*
Phone
form field Phone:
must be in the format: (000) 000-0000
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Date of Birth
Date
form field Date of Birth
must be in the format: MM/dd/yyyy
Is the Address different from the victim?
Yes
No
Parent/Guardian Address
Is the Email different from the victim?
Yes
No
Parent/Guardian Email
Is the Phone Number different from the victim?
Yes
No
Parent/Guardian Phone number
Phone
form field Parent/Guardian Phone number
must be in the format: (000) 000-0000
Animal Information
Animal Color:
*
Animal Name:
Animal Type: (dog ,cat ,etc...)
*
Value is not selected
-- Select one --
Dog
Cat
Bat
Coyote
Raccoon
Fox
Skunk
Opossum
Horse
Goat
Sheep
Pig
Llama
Other
Please specify what kind of animal:
Sex:
*
Value is not selected
-- Select one --
Male
Female
Unknown
Breed: (pitbull, shepherd, etc...)
Is the animal known to the victim:
Yes
No
Clear
Animal Behavior:
The animal was behaving abnormally
The animal was provoked
Clear
Animal Owner's Information
First Name:
*
Last Name:
*
Address:
Phone:
Phone
form field Phone:
must be in the format: (000) 000-0000
Location of Bite:
Select the body part(s) bitten
Unfortunately, only one Human Body Selector is currently supported on the page. However, you can still interact with the checkboxes/multi-select controls.
Select the body part(s) bitten
*
Front side
Back side
Bite Information
Date of Bite:
*
Date
form field Date of Bite:
must be in the format: MM/dd/yyyy
Time of Bite:
*
AM/PM:
*
AM
PM
Where Bite Occurred: (Sidewalk, Friend's House, etc...):
*
Nearest Address or Cross Street Where Bite Occurred:
*
Please provide us with any additional information:
Victim's Treatment Information
Type of treatment (Check all that apply):
Type of treatment (Check all that apply):
Antibiotics
Wound care
Tetanus (Tdap) vaccine
Pain management
Sutures
Surgery
Rabies vaccine series
Treated by (if known) physician or facility name:
Date of Treatment:
Date
form field Date of Treatment:
must be in the format: MM/dd/yyyy
555-555-5555
Phone:
Phone
form field Phone:
must be in the format: (000) 000-0000
Email Address:
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