Independent Animal Care Services LLC

Please submit the form below to report an Animal Bite incident.

Notification of Animal Bite

Person Reporting Bite:*

Enter your E-mail:*

Date of Incident:

Location of Incident:

Case Number (if available):

Victim Name:

First

Last

Victim Address:

Street AddressCityPostal / Zip Code

Victim Phone:

Area Code

–

Phone Number

Animal Owner Name:

Animal Owner Address:

Street AddressCityPostal / Zip Code

Animal Owner Phone:

Area Code

–

Phone Number

Were the injuries sustained to a:

Person

Animal

Both

No Injuries

Classification of Injuries:

Enter your Message. Please include a description of the animal(s) involved:

Send a copy of this message to yourself: