Dog Bite Incident Report Name Interviewer Information Your Name * Your Email * Dog Information Name of Dog * Dog's ID Number * Date of Bite/Exposure * Name of Person Bitten? * Address of Person Bitten? * Phone Number of Person Bitten? * Parent's Name and Phone Number (if minor was bitten): Type of Exposure * Bite Scratch Both Skin Broken? * Yes No Drew Blood * Yes No Location of Wound(s): * Location of Incident: * Describe in detail what caused our little one to bite. * Was Treatment Provided? * Yes No If yes, describe treatment provided: What other information do you feel we should know. * Verification Please enter any two digits * Please click the submit button only one time. When you see the thank you message, your form was submitted.
