It is extremely important that you provide as much information as possible to assist us in investigating the incident. Please fill out the online form completely.

Since animal bite reporting is required by State Law, a copy of your report will be sent to the Merced County Health Department. The appropriate investigating agency will be contacted.

Person Making Report

First Name:*

Last Name:*

Relationship?*

Select one Parent/Guardian Care Provider Medical Practitioner Neighbor Friend Self Other

Contact Number (111-222-333):*

Email Address:

Person Bitten

First Name:*

Last Name:*

Age:*

Address (Number, City,State,Zip):*

Contact Number (111-222-3333):*

Email Address:

Bite Information

Nearest Cross street/Address & City where bite occurred*

Where Bite Occurred*

Public Sidewalk Roadway Fenced Yard

Parking Lot Vehicle Other

How did the bite occur*

Location of Wound *

Arm Hand Face/Head

Leg Foot Torso

Type of wound*

Minor Moderate Severe Hospitalization Bruise(s)

Abraision (scrape) Puncture(s) Laceration(s) Scratch

Date of Bite (MM/DD/YY)*

Time (AM/PM)*

Date Treated (MM/DD/YY)

Treated By

Address (Number, City,State,Zip):

Contact Number (111-222-3333):

Describe Treatment

Animal Information

Describe the Biting Animal*

Dog Cat Wildlife Farm Animal Other

Family Pet Stray Owned Wild

Animal Name (If Known)

Sex

Unknown Male

Female

Rabies Vaccination

Unknown Yes

No

Describe the Animal (color, markings etc)*

Owner Information (If Known)

First Name:

Last Name:

Address (Number, City,State,Zip):

Contact Number (111-222-333):

Additional Comments