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Animal Bite Reporting Survey

Animal Bite Reporting Survey

This question requires a valid date format of MM/DD/YYYY.
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2. Time bite occurred
3. Full name of person who was bitten *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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6. Phone number of person who was bitten (with area code)
7. Address of person bitten
11. Animal owned by _______ *This question is required.
Name of animal owner
This question requires a valid date format of MM/DD/YYYY.
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Phone number of animal owner (with area code)
Address of animal owner
12. What kind of animal caused the bite? *This question is required.
13. Who is reporting this bite incident? Choose what best applies:  *This question is required.
Animal location
This question requires a valid date format of MM/DD/YYYY.
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Was the animal euthanized or did the animal die? 
This question requires a valid date format of MM/DD/YYYY.
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What is the physician's information of the person bitten? (this is required for rabies testing)