Animal Bite Report

Please complete this form if you or your child have been bitten or scratched by an animal or exposed to a bat or other animal that could have rabies.

Our staff will contact you within two business days to ask additional questions and determine if the animal needs testing and/or if the exposed person needs medical treatment.
If you are completing this form after hours or on the weekend, please seek medical care if an animal has bitten or scratched someone.
If you find a bat in your house, please complete this form as we provide case-by-case consultation regarding the need for post-exposure prophylaxis.
DO NOT bring live bats to the Health Department.
Please only use this form to report an animal bite or bat exposure for someone who lives in Allegan County, or if the incident occurred in Allegan County, Michigan.
This form is secure and HIPAA compliant. Please provide as much detail as possible.

1. Please enter your information below about the person who was bitten, scratched, or exposed:

First Name
Last Name
Address (include City, State, ZIP)
Phone Number
Email
Date of Birth (MM/DD/YYYY)
Today's Date (MM/DD/YYYY)

2. Please enter the information below about the owner of the animal (Write unknown if not sure)

First Name
Last Name
Address (Include City, State, ZIP)
Phone Number
Email

3. Please enter the information below about the location the bite, scratch, or exposure occured:

Date of Exposure (MM/DD/YYYY)
Approximate Time of Exposure
Address of Incident (include City, State, ZIP

4. How was the person exposed?

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

5. Is the animal a feral or wild animal?

6. Was the bite, scratch or exposure provoked or unprovoked?

7. What is the current location of the animal?

8. Has the person who was bitten, scratched or exposed contacted or visited a doctor, hospital, ER, urgent care, or other healthcare provider or facility for this incident?

9. Was anyone else exposed or bitten?

10. Please describe the bite or exposure incident:

11. Please share any other information that could be helpful for the Allegan County Health Department to know at this time: