Dog Bite Information Center

Dog Bites Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

What breed of dog attacked you?

When did the attack occur?

Where did the attack occur?

Who owns the property where the attack occurred?

Do you know the owner?
Yes  No 

Why were you on the property at the time of the attack?

When did you first have contact with the animal?

Has the dog ever attacked you or anyone you know?
Yes  No 

Had the dog exhibited vicious behavior prior to the day in question?
Yes  No 

Was the dog restrained at the time of the attack?
Yes  No 

Do you know of any prior attacks or vicious acts by this animal?
Yes  No 

What were you doing during the moments just before the attack?

Do you know why the dog attacked you?
Yes  No 

How were you injured?

Were you taken to a hospital?
Yes  No 

How has the attack affected your life?

Special concerns:

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