ANIMAL BITES REFERRAL FORM
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ANIMAL BITE REFERRAL TO ST.LOUIS COUNTY PUBLIC HEALTH

It is imperitive to submit this online form to St. Louis County Public Health Office within 24 hours of the incident.

Phone lines: Public Health South 218-725-5210, Public Health North 218-471-7600.


Date of Report Taken
Report Taken By
First Name
Last Name
Title/Position
Agency
Agency Address
Street Address
City
State/Province
Postal Code
Agency Email
Agency Phone
Phone Number
Other Phone
Phone Number

PERSON BITTEN INFORMATION
Person Bitten
First Name
Last Name
Middle Name
Birthdate
Age
If minor, parents name
First Name
Last Name
Address
Street Address
City
State/Province
Postal Code
Phone
Phone Number

DESCRIPTION OF INCIDENT
ICR#(optional)
Date Bitten
Time Bitten
Location of bite(s)
Skin Broken
Explain Situation
File Upload(Optional for additional information)
Files types accepted: images, pdf, video

ANIMAL INFORMATION
Type and description of animal
Check one
Owner Name
Owner Middle Name
Owner Date of Birth
Owner Address
Owner Phone
Animal has had rabies vaccine
Vaccine Date
Veterinarian
Clinic
Animal is available for
Current Location of Animal