Bite Incident Report Form

Bite Incident Report Form

Please complete every section to the best of your ability.
Thank you for taking the time to report this incident.

California law (Title 17, California Code of Regulations, §2606) requires that all animal bites that break the skin be reported to the local health authority. This ensures that potential rabies exposures are investigated promptly and that both people and animals receive appropriate care.

Please complete this form as accurately and completely as possible. A member of Marin Humane’s Animal Services team may contact you for clarification or follow-up.

If this is an emergency or a life-threatening injury, please call 9-1-1 or seek immediate medical attention before submitting this form.
By submitting this form, you acknowledge that the information provided is true and accurate to the best of your knowledge.
Please acknowledge

What is your full name (person completing this form)?

First NameLast Name
What is your relationship to the bite victim?

Other
What is the date of birth of the victim?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What is the best phone number to contact you?
Please enter a valid phone number.Format: (000) 000-0000.
What is your email address?
example@example.com
What is your best contact method?
What is your mailing address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check here if physical address is same as mailing address
What is your physical address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is the date that this incident took place?

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Approximately what time did the incident take place?

Hour Minutes

AM/PM Option
What is the location/address of the incident?
What is your involvement in this incident (e.g., animal owner, bystander, pet sitter, neighbor, etc.)?
Description of animal(s) involved (including physical description and name(s), if known).
Please write a detailed description of the incident (what happened before, during, and after the incident). If more space is needed, please upload a document.
If known, what is the name of the owner/guardian?
If known, please provide the owner/guardian's address and contact information.
Did you speak with the owner/guardian? If so, what happened during that interaction?

Please describe any injuries sustained by you and/or your pet(s) during the incident.
Did you receive medical treatment? If yes, please describe.
⚠️ Please upload photographs of any injuries to people and/or animals (label documents). Please note: we typically cannot proceed without photo documentation.

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Please upload any photographs of the incident location e.g., site photos or Google maps satellite images (label documents)

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Please upload all medical files related to this incident for you and/or your pet(s) (label documents)

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Any other documents you would like to share e.g., witness statements including name, address, phone numbers; veterinary or medical statements; copies of records, etc. (label documents)

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The information contained in this form is intended solely for the use of the named recipient(s) and will not be stored or shared with any third parties.
I understand that by submitting this form, I am certifying under penalty of perjury under the laws of the State of California that my statement is true and correct to the best of my knowledge.
Today's Date

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Should be Empty: