Use this form to report Animal Bites that have occurred within your jurisdiction. The information will be sent directly to the Merced County Health Department.

To report a bite that has occurred in the unincorporated area of Merced County please use the public Animal Bite Form.

Reporting Agency*

Atwater PD (209) 357-6388 Dos Palos PD (209) 392-2177 Gustine PD (209) 854-3737 Livingston PD (209) 394-7916

Los Banos PD (209) 827-7070 Merced PD (209) 385-6905 Merced County AC (209) 385-7436

Contact Name:*

Email Address:

Person Bitten

First Name:*

Last Name:*

Age:*

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

Contact Number (111-222-333):*

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)

Date of Bite (MM/DD/YY)*

Time (AM/PM)*

Date Treated (MM/DD/YY)

Treated By

Address (Number, City,State,Zip):

Contact Number (111-222-333):

Describe Treatment *

Wound Care Antibiotics Tetanus Vaccine (or current) Rabies Vaccine Series

Other None Unknown

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