Dog Surrender – Bite History Addendum – Dog to Human

Your name*

First Last

Your dog's name*

When was the incident? If you don't know the exact date, please give an estimate of when/how long ago.*

Please describe the person/people bitten. Please include age, gender, actions, e.g. 10-year-old boy waving stick.*

Does the dog (please check one):*

Live with the person
Know the person well (met more than 10 times)
Only met a few times
Never met

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 your dog's body language or facial expression (including tail and ear position and overall body posture) before, during or after the incidents.*

Describe the bite (please check one):*

Where was the bite (e.g. arm, leg, etc)?*

Was the bite been reported to Animal Control or other authorities?*

Yes
No

Which town?*

Please include any pictures of the bite

Drop files here or

Max. file size: 100 MB.

Bite History Addendum - Dog to Human

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