Animal Quarantine Update Survey

CDC lists the following as signs of rabies in animals: The first symptoms of rabies may be nonspecific and include lethargy, fever, vomiting, and anorexia. Signs progress within days to cerebral dysfunction, cranial nerve dysfunction, ataxia, weakness, paralysis, seizures, difficulty breathing, difficulty swallowing, excessive salivation, abnormal behavior, aggression, and/or self-mutilation. For more information please visit https://www.cdc.gov/rabies/index.html This form is secure and HIPAA compliant.

1. Please list your information below:

	First Name
	Last Name
	Address (include City, State, ZIP)
	Phone Number
	Email
	Today's Date

2. What type of animal are you reporting quarantine information for?

Please enter an 'other' value for this selection. * This question is required.

3. Does the animal have their rabies vaccine?

4. What is the name of the veterinary clinic where your pet was vaccinated?

4. What was the date of the bite or exposure? (DD/MM/YYYY) (Animals should be quarantined and monitored for signs and symptoms of rabies for 10 days following the exposure/bite incident)

Please verify that you have reviewed the list of rabies symptoms listed above from the CDC and that your animal is not displaying any of these symptoms. If your animal appears ill or has any of the symptoms listed above, please contact your veterinarian and Allegan County Health Department (269-673-5411) immediately.