Animal Bite Report Form
Anaconda-Deer Lodge County Public Health Department
Bite Victim Information
Name
DOB
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Animal Information
Animal Name if applicable
Species
Breed
Physical Description
Current Health Status and Location
Animals Veterinarian if applicable
Up-To-Date Rabies Vaccine?
Yes
No
Unknown
Animal Owner Information
If applicable
Name
DOB
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Bite
/
Month
/
Day
Year
Date
Area of body
Skin Broken?
Yes
No
Post-Bite Precautions already taken
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