Animal Health Confirmation Form

Animal Health Confirmation Form
This form should only be completed if you received a letter from the Health Department asking you to keep your animal confined for 10 days and then submit health documentation.

If you are looking to report an animal bite, please fill out the Animal Bite Report Form instead.

Please use this form to upload the following documents:
1. Proof of Health Photo - This photo of your pet must be taken at least 10 days after the date of the bite/scratch.
2. Rabies Vaccination Certificate - This document can be obtained from your veterinarian. Rabies tags will not be accepted.
Owner Name*

First NameLast Name
Owner Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Owner Email Address*
Your email address will only be used to send you a confirmation email after this form is submitted.
Owner Phone Number*
Please enter a valid phone number.
Case ID Number*
The Case ID is located on the top right corner on the letter you received from the Health Department. If you did not receive a letter or do not know your case ID, please call (610) 344-6452.
Please upload your pet's Proof of Health photo (taken at least 10 days after date of bite/scratch):*

Cancelof
Please confirm that the uploaded photo of pet was taken at least 10 days after the date of the bite/scratch.*

Yes, I confirm.
On the date of bite/scratch, was your pet up to date on their rabies vaccines?*

YesNo
Please upload Rabies Vaccination Certificate. Rabies tags will not be accepted.*

Cancelof
Please confirm that the information provided on the Rabies Vaccination Certificate is accurate.*

Yes, I confirm.
Should be Empty: