Report an Animal Bite

You must report any type of animal bite within 24 hours of the event. All personal information you include in this form is confidential.

* Indicates required fields

General Information

Date of Bite*

Animal Species*

Animal Ownership

Owned

Unowned

I don't know

Animal Breed

Animal Colors

Animal Owner's Last Name

Animal Owner's First Name

Animal Owner's Phone

Animal Owner's Address

Animal Owner's City

Animal Owner's

Animal Owner's ZIP Code

Person Bitten Last Name*

Person Bitten First Name*

Person Bitten Sex at Birth

Male Female

Person Bitten Age

Person Bitten Address*

Person Bitten City*

Person Bitten State*

Person Bitten ZIP Code*

Borough Where Incident Occurred*

Person Bitten Phone

Area of Body Bitten

Patient's Activity at Time of Bite

Location of Occurrence (address, cross streets, landmark, etc.)

Person Reporting Last Name

Person Reporting First Name

Has the person bitten obtained medical treatment?

Yes No

Are you the person bitten?

Yes No

Person Reporting Address

Person Reporting City

Person Reporting State

Person Reporting ZIP Code

Person Reporting Phone*

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