Fight or Bite with Animal QuestionnairePlease enter your email address:* First name of animal:* Last name of animal:* Species of animal: Dog Cat Other If you selected other, please indicate the species. How many times has this animal bitten or snapped at another animal?*Please complete a form for each separate incident. If your animal has bitten or snapped multiple times, please complete a form for the 3 most serious incidents. Date of Incident:* MM slash DD slash YYYY Species of animal bitten:If other, please explain in the next section. Dog Cat Chicken Livestock Wildlife Other If other, please explain: Did the animal need veterinary attention?*If yes, please explain (stitches, surgery, drains placed, etc). Name of vet hospital, if known: Was the incident reported to animal control?*If yes, which jurisdiction? Please document any warnings/citations and outcome of the situation. Fully describe the circumstances surrounding the bite/fight incident:* Location of bites on the body:* Please check the best description of the bite: Snapped only — no contact Made contact but no broken skin or damage Pinched skin and caused bruising or pulled out hair of other animal Shallow scrape without puncture Single puncture from single bite Multiple punctures from single bite Multiple punctures from multiple bites Internal injuries Deep laceration(s)/ripped skin Single puncture from single bite – describe depth of puncture: Multiple punctures from single bite – describe number and depth of punctures: Internal injuries – describe: If the bite caused deep laceration(s)/ripped skin, were stitches or staples required? If so, how many? Please provide any additional details regarding this bite occurrence:Upload a photo of injuries (optional).Max. file size: 50 MB.
