You should report any type of animal bite within 24 hours of the bite so the NYC Health Department can assist you with guidance and information. All personal information you submit is confidential.
General Information

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* 1. Date of Bite

Date

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* 2. Animal Species

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* 3. Animal Breed

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* 4. Animal Colors

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* 5. Animal Ownership

Animal Owner's Information

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* 6. Animal Owner's First Name

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* 7. Animal Owner's Phone

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* 8. Animal Owner's Address

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* 9. Animal Owner's City

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* 10. Animal Owner's State

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* 11. Animal Owner's ZIP Code

Person Bitten Information

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* 12. Person Bitten Last Name

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* 13. Person Bitten First Name

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* 14. Person Bitten Sex at Birth

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* 15. Person Bitten Age

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* 16. Person Bitten Address

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* 17. Person Bitten City

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* 18. Person Bitten State

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* 19. Person Bitten ZIP Code

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* 20. Borough Where Incident Occurred

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* 21. Person Bitten Phone

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* 22. Area of Body Bitten

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* 23. Patient's Activity at Time of Bite

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* 24. Location of Occurrence (address, cross streets, landmark, etc.)

Person Reporting Information

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* 25. Person Reporting Last Name

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* 26. Person Reporting First Name

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* 27. Has the person bitten obtained medical treatment?

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* 28. Are you the person bitten?

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* 29. Person Reporting Address

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* 30. Person Reporting City

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* 31. Person Reporting State

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* 32. Person Reporting ZIP Code

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* 33. Person Reporting Phone

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