Henry County Animal Control Bite Report by 807aZ58a

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             Henry County Animal Control Bite Report Information
                              Attention: Vince Farah, Rabies Control Officer
               (This Report should be sent to Animal Control VIA Fax @ 770-288-7432 A.S.A.P.)
                                Or E-Mail to: vfarah@co.henry.ga.us

Date of Incident: _________________             Incident Time: ___________Am / Pm

Victim Name: ______________________ (if Minor Parents Name)_________________________________

Address: _______________________________________City: __________________

DOB: ___________ Sex: ___________ Phone# _____________ Cell #: _____________
                             (NOTE: All reports will be followed up by a phone call)

Part of Body: Bitten / Scratched __________________________ Skin Broken Yes / No
                (Circle One)                                                            (Circle One)

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Treated at: ________________________________ City: ____________________

Contact Person: ___________________________ Phone # __________________
(Please Print)
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Animal Owner: ________________________ Phone: ____________ Cell: ___________

Address: ________________________________ City: ______________ State: _______


Animal Description: Species: ________ Breed: _________ Age: ______ Color: _______

(If known)
Male: _____ Female: _______ Name: ________________ Rabies Tag #_____________


Vets Name: _________________________________ City: _______________________

Description of Incident:

________________________________________________________________________

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VOICE # 770-288-7387
FAX # 770.288.7432 Date Sent: __________ Senders Name: _____________________
E-Mail: vfarah@co.henry.ga.us

								
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