Dog Bite Victim Information

Please use this form to give us information about the bite you or a dependent has suffered.

Name of Victim(Required)
Name of Form Preparer(Required)
Victim's Address
If the victim is a minor, please list parent or guardian contact.
Address nearest to where the bite/injury occured:
If you do not have or know the address, the deputy following up on the report with help you.
MM slash DD slash YYYY
Time the bite/injury occurred:(Required)
:
Name of dog owner (if known)
Address of dog owner (if known)
Select the answer that most closely reflects your injury.
Choose the best option.
How was the dog confined?(Required)
Was the victim's skin broken due to bite or scratches from dog?(Required)
Do not include skin broken from a fall or other injury the dog may have caused, but was not a bite or scratch.
What type of medical care or first-aid treatment was sought?(Required)
What type of medical treatment was done? (Select all that apply.)
Max. file size: 128 MB.
If you can not upload pictures, please email to: kmahoney@co.lucas.oh.us Include your name and address in subject line. Pictures may also be printed and mailed or taken to: Lucas County Canine Care & Control attn: Officer Mahoney 410 S. Erie St. Toledo, OH 43604