Survey - Bite Report (Dog to Animal) - San Diego Humane Society

Bite Report (Dog to Animal)

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

Name:

First Required	Last Required

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

Mobile Phone: Required

Date of Birth:

Yes, I would like to receive e-mail from San Diego Humane Society

Yes, I would like to receive postal mail from San Diego Humane Society

Bite Information

Question - Required - Address / Location where Bite Occurred:

Question - Required - Time of Bite:

Question - Not Required - Date of Bite:

Month

Day

Year

Question - Required - Did the Bite Break Skin:

Yes

Circumstance of Bite

Question - Required - Incident Details:

Animal Owner Information

Question - Not Required - Name:

Question - Not Required - Address:

Question - Not Required - Apt #

Question - Not Required - City:

Question - Required - State:

Question - Required - Zip:

Question - Not Required - Dog Owner's Telephone Number:

Animal Description Information

Please describe the animal that caused the injury.

Question - Not Required - Type of Animal:

Question - Not Required - Breed of Animal:

Question - Not Required - Sex of Animal:

Male

Female

Question - Not Required - Animal Name:

Question - Not Required - Animal Color:

Question - Not Required - Animal Age:

* These fields are required to submit this form.