Dog Bite

This Dog Bite form only applies to incidents where a dog has bit a human.

Mandatory bite reporting is required only if the teeth make contact with the skin resulting in a break to the skin (as in a puncture). If the bite makes contact with clothing such as a jacket and the teeth did not tear through the clothing to make skin contact, it is not considered a ‘reportable bite.’ For incidents where a dog was aggressive but did not break skin, or a domestic animal was bit, please use the Animal Complaint form located under the “I WANT TO” heading above to report a Vicious Dog.

"*" indicates required fields

Address of Incident*

Street Address Address Line 2 City State ZIP Code

Date Occurred*

Time Occurred*

Name of Victim*

First Last

Address of Victim*

Street Address Address Line 2 City State ZIP Code

Phone Number of Victim*

Date of Birth of Victim*

Name of Parent/Guardian (if victim is a minor)

First Last

Email for Contact

Brief Description of Circumstances*

Brief Description of Injuries*

Description of Dog (any information known)*

Animal Owner Name (if known)

First Last

Animal Owner Address (if known)

Street Address Address Line 2 City State ZIP Code

Animal Owner Phone Number (if known)

Dog's Rabies Expiration (if known)

Dog's Veterinarian (if known)

First Last

Was the victim seen by a medical professional?*

Yes

If yes, medical facility information

Comments

This field is for validation purposes and should be left unchanged.

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