Animal Bite Report

SHELTER CLOSED: AWLA will be closed to the public on November 3, 2026 | Animal Control / Wildlife Assistance - (703) 931-9241

Please fill out this form to the best of your ability. Once this form is submitted, an Animal Control Officer will be in touch with you as soon as possible. If you are experiencing a medical emergency, please call 911 or go to the nearest hospital.

Date/Time of Report:*
Reporting Facility:
Incident Description
Date of Incident
Time of Incident*

: Hours

Minutes

AM/PM
Address of Incident:*
Street Address Address Line 2 City State ZIP Code
Description of Incident*
Victim Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Is victim under 18 years old?*
- Yes
- No
Please give the name of parent/legal guardian:*
Hispanic origin (select one only):
- Hispanic or Latino
- Not Hispanic or Latino
Race: (may select one or more)
- African American/Black
- Asian
- Native Hawaiian or other Pacific Islander
- American Indian/Alaska Native
- White/Caucasian
Type of injury:
- Bite
- Scratch
Description of injury, including where on the body the injury is located:*
Did victim receive medical treatment?*
- Yes
- No
Please give the name of facility where treatment was received:
Exposure Information
Animal Species*
- Dog
- Cat
- Wildlife
Please give the pet's name if known:*
Sex of animal:*
- Male
- Female
- Unknown
Please describe the animal:*
Is the animal spayed/neutered?*
- Yes
- No
- Unknown
Approximate age of animal:*
Color of animal:*
Breed of animal:*
Rabies vaccine expiration date:*
Name of Veterinary Clinic:*
County License Number:
Licensing Jurisdiction/County
Animal Owner Information
Is the owner also the victim or parent of victim?
- Yes
- No
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
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