Clackamas County

Animal Bite Report

Bite Information

Date of Occurrence:

Time:

Was the skin broken?

Medical attention received:

If the victim is a minor, please list their guardian's name:

Additional information:

What occurred?

Where did it occur?

Type of animal:

Description:

Animal's current location:

Owner's address (if same leave blank):

Owner's phone (if same leave blank):

Is this a:
Business
Residence

Your Information

Were you:

Name:

Address:

City:

State:

Zip code:

Home phone:

Work phone:

   

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