Environmental Health

Report an Animal Bite/Bat Exposure

Note: If the owner of the animal lives in another county in Iowa, visit the Iowa Health & Human Services website for statewide points of contact.

Animal Bite/Bat Exposure Record

Required fields are marked with an asterisk (*).

Form completed by *
Phone # for person completing form *
Date bite/exposure occurred *
Date treated *

Medical facility treated *

Person Bitten/Exposed to Bat Information

First name *
Last name *

DOB *
Sex *

If minor, parent name
Phone (day) *
Phone (evening) *
Email *
Address
City
State
Zip

What location on your body were you bitten?
Description of Injury
Treatment provided
Were rabies vaccinations given to person bitten?

Animal Information

Address bite/bat exposure occurred
City
State
Zip

Animal type
Breed
Color
Animal name
Age
Owner name
Owner sex
Owner address (If there is no owner, use the address of the bite/bat exposure)
City
State
Zip

Owner phone (day)
Owner phone (evening)

Owner email
Veterinarian name
Vet phone #
Rabies tag #
Expiration date
Quarantined
Where
Circumstances of bite and other related information
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Environmental Health

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Maquoketa, IA 52060
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