Form Center

2. 
3. Animal Bite Reporting Form
   If you or someone close to you has been bitten by an animal in Clear Creek County, please fill out the following information with as much detail as possible.
7. Person Reporting the Bite
9. Name (First and Last)*
10. Phone*
11. Email *
13. The bite victim is:*

    1. Myself
    2. My Child
    3. My Spouse/Partner
    4. My Parent
    5. My Grandparent
    6. My Sibling

    1. My Relative (relation not listed)
    2. My Roommate
    3. My Neighbor
    4. My Friend
    5. Other (please specify)
15. Other:
19. Bite Victim Information
    Please provide information regarding the bite and the victim in as much detail as possible.
21. Name (First and Last):*
22. Phone
23. Email
25. Date of Birth*
    Date of Birth
26. Age of Victim*
27. Location of Bite Wound on Victim*
    Where on the victim did the bite impact?
29. Did the Victim Seek Medical Attention:*

    1. Yes
    2. No
30. Location and Name Hospital or Clinic:
32. Phone Number of Hospital or Clinic
33. What Medical Treatment Occurred:
37. Details About the Bite
    Please provide as much detail as possible regarding the bite incident.
39. Date and Time Bite Occured*
    Date and Time Bite Occured

    Date and Time Bite Occured
40. Location Where Bite Occured*
    Please provide information on where in Clear Creek County the bite occurred. This may be an address, intersection, trail head or trail, etc.
42. Type of Animal Who Bit the Victim*
    -- Select One --Domestic DogStray DogDomestic CatStray CatFerretBatRaccoonCoyoteSkunkOther (please describe)
43. Other:
45. Breed of Animal (if known):
46. Color of Animal:
48. Animal Owner Name (if applicable):
49. Animal Owner Phone Number (if known):
51. Animal Owner Physical Address (if known):
53. Please describe the incident in as much detail as possible:*
55. Please upload any pictures or important documents related to the incident:
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field