Bite Report

 

Please use the below form to report an animal bite that caused injury to a human. To notify San Diego Humane Society Law Enforment of an animal biting another animal, please use this form

To fill out the paper form, please print this PDF file. 

 


 
Please provide your contact information:
  This form was completed by:

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Name:

 

 

   

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City/State/ZIP:

 

    

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Date of Birth:

 

 


 

Please provide information about the bite victim:

This form is to report an animal bite resulting in injury to a human.  To notify San Diego Humane Society Law Enforment of an animal biting another animal, please use this form

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Question - Required - Who was bitten?
Please make between 1 and 2 selections from the choices below.

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Question - Required - Victim's Date of Birth:




 

(Maximum response 255 chars, approx. 5 rows of text)

   


   


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Bite Information
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Question - Required - Severity of Bite:



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Question - Not Required - Date of Bite:




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Question - Required - Did the Bite Break Skin:


 
Circumstance of Bite
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Hospital Information
   


   


   


   


 
Question - Not Required - Date of Visit:




 

Animal Owner Information
   


   


   


   


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Question - Required - State:

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Animal Description Information

Please describe te animal that caused the injury. 

   


   


 
Question - Not Required - Sex of Animal:


   


   


   


 

* Are feilds we need filled out before you can submit this form. 

   Please leave this field empty