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Bite or Scratch Incident Report

Thank you for taking the time to fill out this form.

The information you provide is critical. This will give us the best chance of setting the animal up for success going forward. Please share as much information as possible.

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Today's Date*
MM slash DD slash YYYY
Please tell us about you
Your Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*

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Please tell us what happened
Date of Incident*
MM slash DD slash YYYY
Species*
- Dog
- Cat
Animal's name?*
Where was the bite or scratch (e.g. arm, leg, etc)?*
Please describe the bite or scratch (please check one):*
- No mark
- Small red mark/scratch, didn't break skin
- Bruised, didn't break skin
- Broke skin, minor scrape
- Broke skin, punctures
- Multiple punctures
- Punctures and tore flesh
- Multiple bites at one time
Did you seek medical treatment (beyond first aid)?*
- Yes
- No
If you sought medical treatment, would you please tell us more:*
Please describe/include, if applicable: where the incident occurred, who else (human and animal) was present, what happened just before the incident, and other information relating to the incident.*
Please describe/include, how everyone (human and animal) present reacted after the incident.*
If observed, please describe changes in the animal's body language or facial expression (including tail and ear position and overall body posture) before, during or after the incidents.*
Please share any suggestions you have on how this could be avoided in the future?
Phone
This field is for validation purposes and should be left unchanged.

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Baypath Humane Society of Hopkinton | 500 Legacy Farms North, Hopkinton MA 01748