Free printable dog bite and animal attack worksheet

Dog Bite Intake Form for Law Firms: Owner, Animal & Injury Questions

Use this staged dog bite intake form to preserve the first account, identify the animal and reported owner or keeper, route safety and public-health questions, inventory reports and evidence sources, and prepare an attorney-review handoff without deciding liability, local reporting duties, medical treatment, deadlines, value, conflicts, or representation.

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Published by ClaimVela · Updated October 20, 2026 · This operational resource is not legal advice, medical advice, public-health advice, or a universal form. Have authorized counsel adapt every question, safety statement, notice, consent, conflict control, reporting workflow, escalation rule, and communication step to the firm's jurisdictions and procedures.

Direct answer

A useful dog bite client intake form records a limited, conflict-safe snapshot first: who was injured, when and where the event happened, how the animal and reported owner or keeper were identified, what care or official response already occurred, and which witnesses or evidence sources reportedly exist. Detailed medical, insurance, animal-history, vaccination, quarantine, and report records belong in a gated follow-up after the firm's approved conflict and authorization process.

Route safety first. Pause intake for the firm's approved emergency, clinical, or local public-health routing when a caller reports a concern.

Identify; do not infer. Keep reported breed, ownership, custody, location, and prior information tied to their sources.

Assign the handoff. End with a named reviewer, specific next action, and due time.

Stage 0 · Safety and public-health routing

Do not let the worksheet delay care

Before continuing, ask only enough to use the firm's approved routing procedure. A reported emergency such as uncontrolled bleeding or faintness or weakness should pause routine intake. Possible rabies exposure, unknown vaccination status, multiple bites, head or neck exposure, a young child, a deep wound, or signs the caller describes as infection should follow the firm's reviewed instruction for prompt clinical and local public-health assessment. Intake staff do not diagnose, assess rabies or tetanus risk, decide whether treatment is needed, or substitute this form for emergency, medical, or public-health services.

Reported emergency

Pause the form and use the firm's approved emergency instruction, including local emergency services when appropriate.

Clinical or rabies concern

Route to a healthcare professional and local or state health department under reviewed policy. Staff do not decide risk or care.

Document the route

Record the caller's words, time, approved language used, action taken, delivery result, and internal escalation owner.

Stage 1 · Limited first contact

Preserve a conflict-safe dog bite snapshot

These opening groups cover the minimum useful first record. Gather known people and organizations for the firm's duplicate and conflict process, use neutral wording, allow unknown answers, and defer detailed medical files, insurance credentials, full vaccination or veterinary records, unnecessary child identifiers, and other sensitive material until the approved gate.

Inquiry control and safe contact

Create one accountable record and a permitted path for the firm to respond.

Inquiry ID, received date and time, source, channel, referral, and campaign
Caller name, injured person's name, and their relationship if different
Parent or guardian name and role when the injured person is a minor
Phone, email, preferred method, safe contact times, and message restrictions
Inquiry-contact permission and the notice version, timestamp, and recorded action
Optional marketing consent kept separate from required inquiry contact
Preferred language, accessibility needs, local time zone, assigned owner, and response target

Incident and location snapshot

Preserve the caller's first account without deciding fault, provocation, permission, control, or legal responsibility.

Incident date and approximate time, with estimates and unknown details labeled
Exact location, address, unit, yard, sidewalk, park, business, workplace, school, vehicle, or other setting
Short neutral sequence in the caller's own words, including what happened immediately before and after
Whether the person was working, visiting, delivering, entering, leaving, walking, riding, or engaged in another activity
Leash, enclosure, gate, fence, tether, warning, restraint, or animal location as directly observed or reported
Whether police, animal control, EMS, a health department, property staff, or another responder reportedly attended

Animal and visible identifiers

Record neutral identifiers that can support duplicate, conflict, report, and authorized follow-up review.

Animal type, name, color, approximate size, age, sex, distinctive markings, tag, license, or microchip information already known
Reported breed or breed description and the identified source; never infer breed or use it as a fault or danger conclusion
Owner, keeper, handler, walker, sitter, rescue, business, employer, or other reported custodian
Animal location after the incident, if already known, without directing anyone to locate, approach, retrieve, or interfere with it
Vaccination, veterinary, license, quarantine, or testing facts already known and the source for each fact

People, property, and possible conflict names

Capture reported names and roles for the firm's conflict process without reaching an ownership, possession, agency, or premises-control conclusion.

Animal owner, keeper, handler, walker, sitter, household member, or other involved person
Property owner, occupant, landlord, manager, business, employer, school, municipality, rescue, shelter, or vendor reportedly connected to the location or animal
Witnesses, responders, treating facility, veterinarian, or other known organizations
Exact spellings, trade names, unit or suite numbers, name variations, and unknown identities
Caller-reported role and information source for every person and organization

Injuries, immediate care, and reports

Record reported effects and care so staff can route the inquiry without diagnosing or recommending treatment.

Reported bite, scratch, knockdown, fall, or other contact and affected body area and side
Emergency response, transport, hospital, urgent care, primary care, or other care already received
Current safety or medical concern and whether care is underway
Animal-control, police, public-health, workplace, school, business, or other report and number when already known
Current or prior attorney contact or representation concerning the incident

Evidence-source snapshot and next action

Identify possible sources and assign internal review without directing collection, confrontation, or outside contact.

Witnesses and whether photos, video, surveillance, clothing, messages, reports, or other records reportedly exist
Animal-control, veterinary, vaccination, license, quarantine, testing, police, EMS, 911, or property records reportedly possible
Reported custodian, identifier, current location, and possible change or loss risk for each source
Whether insurance or other communications reportedly exist; defer detailed claim, carrier, adjuster, and document collection until the approved gate
Next internal action, authorized owner, due date and time, time zone, and approved channel

Firm-defined prompt review

Route signals; do not make liability or health conclusions

Train staff on the firm's authorized response before these facts appear. A signal should change routing or priority—not answer medical risk, local reporting, quarantine, ownership, control, notice, liability, deadlines, value, coverage, conflicts, or case acceptance.

Immediate danger, uncontrolled bleeding, faintness or weakness, or another reported emergency

Pause ordinary intake and use the firm's approved emergency-routing language, including local emergency services when appropriate. Intake staff do not diagnose or provide treatment instructions.

Possible rabies exposure, unknown vaccination status, multiple bites, head or neck exposure, a young child, a deep wound, or reported infection signs

Use the firm's counsel- and clinician-reviewed instruction for prompt medical and local public-health assessment. Do not decide rabies risk, post-exposure prophylaxis, tetanus care, infection, or treatment.

A court, agency, insurer, property representative, employer, or other document states a response date

Preserve the exact document and stated date, then route it promptly to an authorized attorney. Do not calculate a deadline.

A camera recording, animal-control file, physical item, vaccination record, property condition, or other possible source may change or no longer be available

Record what reportedly exists, where it is, and who reportedly controls it, then escalate under firm policy. Do not issue, recommend, or promise a preservation demand.

A death, serious injury, minor, multiple injured people, service animal, law-enforcement animal, stray or wild animal, workplace, school, government property, or firm-defined urgent circumstance is involved

Send the known facts to the firm's authorized review owner. Treat the category as a routing input, not a liability, value, coverage, reporting, or deadline conclusion.

The person has current or prior counsel or may have signed a representation agreement

Record the person's words and available documents, then request authorized review. Do not advise the person to end another relationship.

A duplicate, related inquiry, owner, keeper, handler, property contact, witness, organization, or other possible conflict input appears

Pause ordinary qualification, limit access under firm policy, and use the firm's conflict process. Intake staff do not clear conflicts.

Stage 2 · Gated follow-up

Build a source-aware animal and incident record

Ask these deeper questions only after the firm's conflict process and an authorized reviewer determine that the information is reasonably necessary. Keep ownership, custody, control, vaccination, quarantine, prior incidents, permission, reporting, and insurance status labeled reported or unknown until verified through the firm's approved process. Sensitive records and secure collection requests belong here—not in the public or first-contact form.

Animal identity, custody, and records

Animal name, species, reported breed or description, color, size, age, sex, markings, tag, license, and microchip identifiers
Reported owner, keeper, handler, walker, sitter, household, rescue, shelter, employer, or other custodian and source for each role
Vaccination certificate, license, microchip, veterinary, adoption, transfer, training, quarantine, testing, or disposition records reportedly available
Animal location and custody status shown in an existing record—without directing anyone to approach, retrieve, move, hide, release, or interfere with the animal
Confirmed, reported, disputed, unknown, and missing identifiers kept separate

Location, property, and incident sequence

Precise area, route, entry point, barrier, gate, door, fence, leash, tether, vehicle, room, yard, walkway, or other relevant physical setting
What the injured person, animal, handler, witnesses, and others were reportedly doing before, during, and after the event
Reported permission, invitation, work, delivery, customer, resident, guest, child, animal-care, or other context—without deciding its legal effect
Property owner, occupant, landlord, operator, manager, business, employer, contractor, or government entity reportedly connected to the location
Separate direct observation, document information, another person's statement, and unknown details

Reports, vaccination sources, and prior information

Animal-control, police, public-health, EMS, workplace, school, business, property, or other report reportedly created
Agency, report number, responder, event date, status, and source document when already available
Vaccination, quarantine, observation, testing, release, or other status only as stated by the responsible agency, veterinarian, or existing record
Prior incident, complaint, warning, bite, escape, or animal-control contact only when tied to an identified source; do not speculate
Local reporting or public-health questions assigned to an authorized reviewer rather than answered from a universal script

Witness, media, and physical source inventory

Witness names, contact details, location, relationship, and reported observation
Caller-held photos, video, messages, reports, medical discharge papers, receipts, or other records
Visible surveillance, doorbell, body-camera, phone, vehicle, business, municipal, school, or property camera sources
Clothing, damaged personal property, leash, collar, barrier, sign, gate, or other physical source reportedly retained and its current custodian
Source owner, current location, access status, reported change or loss risk, and authorized internal next step—without outside-contact instructions

Care and reported impact

After the approved gate: reported symptoms, wound location, onset, progression, scarring concerns, and current condition in the person's own words
Emergency response, facilities, clinicians, visit dates, diagnostics, procedures, prescriptions, and recommended follow-up shown in available records
Relevant prior symptoms, injuries, treatment, or incidents only when an authorized reviewer determines they are reasonably necessary
Reported work, school, caregiving, mobility, household, sleep, activity, or emotional impact
Sensitive medical images, records, and authorizations collected only through the firm's approved secure process

Insurance, communications, and attorney handoff

After the approved gate: known homeowners, renters, commercial, umbrella, employer, municipal, or other insurance information
After the approved gate: policyholder, claim number, adjuster, forms, statements, authorizations, releases, payments, offers, denials, letters, email, or messages
Focused questions, people, entities, animals, reports, sources, and records requiring authorized attorney review
Jurisdiction-specific issues, local reporting questions, conflicts, engagement status, and legal conclusions reserved for authorized counsel
Review owner, priority, next action, due time, approved communication path, and disposition delivery result

Copyable printable template

Dog Bite Intake Form — Operational Worksheet

Print this dog bite intake questionnaire or translate its sections into the firm's reviewed intake system. Complete detailed or sensitive sections only after the approved conflict and authorization gate. This worksheet inventories reported people, animals, records, and sources; it does not direct anyone to contact an owner, keeper, witness, property contact, insurer, agency, veterinarian, or other potentially adverse person or organization.

A. Intake control — internal

Inquiry ID:

Received date, time, and time zone:

Source, channel, campaign, or referral:

Assigned owner and response target:

Duplicate and conflict-review status:

Safety-routing action and escalation result:

Acknowledgement delivery result:

Notice and consent version, timestamp, and recorded action:

Optional marketing consent kept separate from required inquiry contact:

B. Caller and safe contact

Caller name and preferred name:

Injured person and caller relationship, if different:

Parent or guardian and role, if applicable:

Phone and email:

Approved contact method, times, and message restrictions:

Inquiry-contact permission by channel:

Preferred language and accessibility needs:

Current or prior attorney involvement:

C. Incident and location

Incident date and approximate time:

Address and exact location or area:

Caller's short account in their own words:

Activity and reported sequence before, during, and after:

Leash, barrier, enclosure, warning, permission, or location facts as reported:

Direct observation, reported source, and unknown details:

D. Animal, owner, keeper, and property identifiers

Animal name, species, color, size, age, sex, markings, tag, license, or microchip:

Reported breed or description and source:

Owner, keeper, handler, walker, sitter, household, rescue, or employer as reported:

Property owner, occupant, landlord, manager, business, school, or municipality as reported:

Exact names, addresses, organization names, and name variations:

Reported role, relationship, and source for every person or entity:

E. Injury, care, and impact — after approved gate

Reported bite, scratch, fall, or other contact and body area and side:

Symptoms, onset, progression, and current condition as reported:

Emergency response, facilities, clinicians, and visit dates:

Diagnostics, procedures, prescriptions, and recommended follow-up shown in records:

Relevant prior history only when authorized and reasonably necessary:

Work, school, caregiving, mobility, household, sleep, and activity impact:

F. Reports and animal records — after approved gate

Animal-control, police, public-health, EMS, workplace, school, or property report:

Agency, report number, responder, and status:

Vaccination certificate, license, microchip, veterinary, adoption, or transfer record:

Quarantine, observation, testing, release, or disposition record and issuing source:

Prior incident or complaint information and identified source:

Local reporting or public-health question for authorized review:

G. Witness, media, physical, and communication sources — after approved gate

Witnesses and reported observations:

Photos, video, surveillance, body-camera, 911, messages, or reports:

Clothing, damaged property, leash, collar, gate, sign, barrier, or other physical source:

Known insurance, claim, adjuster, forms, statements, offers, or denials:

Reported custodian, location, access status, and change or loss risk:

Internal review owner and next approved step:

H. Attorney-review handoff — internal

Confirmed facts:

Reported or disputed facts:

Unknown and missing information:

Prompt-review signal and escalation result:

Animal, entity, report, and evidence-source questions:

Authorized reviewer:

Next action, owner, due date and time:

Disposition and communication delivery result:

Printable companion register

Animal & Evidence-Source Register

Accuracy labels

Keep report, record, and verification distinct

Confirmed

Supported by a record the firm has reviewed or directly verified through an approved process.

Reported

Provided by the caller or another identified source but not independently verified.

Disputed

Accounts, identifiers, or records differ; preserve each version and its source without resolving the issue in intake.

Unknown

The person does not know or the information is unavailable; never replace it with an assumption.

Not yet obtained

A specific record or answer is identified but has not been received through an approved process; assign an internal owner and status.

Intake guardrails

Keep identifiers separate from legal and medical judgment

Do not decide fault, negligence, provocation, permission, trespass, ownership, custody, control, notice, knowledge, dangerousness, or liability from intake facts.
Do not apply a universal strict-liability, one-bite, landlord, premises, animal-control, quarantine, vaccination, or reporting rule. Jurisdiction-specific review belongs with authorized counsel and appropriate local authorities.
Record breed only as a reported identifier with its source. Do not infer breed, temperament, dangerousness, causation, fault, value, or outcome from breed.
Do not assess rabies, tetanus, infection, scarring, disability, medical causation, or treatment needs. Use approved emergency, clinical, and public-health routing language.
Do not calculate filing, notice, insurance, government, records-retention, preservation, or other windows or deadlines.
Do not estimate case value, damages, settlement range, coverage, acceptance likelihood, or outcome.
Do not direct the person to contact or confront an owner, keeper, handler, witness, property contact, employer, insurer, agency, veterinarian, or any potentially adverse party.
Do not direct anyone to enter property, approach or interfere with an animal, demand records, issue a preservation request, or advise what to say, sign, post, accept, reject, repair, move, release, or destroy.
Do not collect Social Security numbers, full government identifiers, full dates of birth, insurance credentials, broad medical files, or unnecessary child information during first contact.
Do not state or imply that submission is privileged, creates representation, clears conflicts, accepts the matter, guarantees confidentiality, or promises a secure outcome before the firm's authorized process is complete.

Medical and public-health routing

Route; do not assess

CDC guidance supports prompt healthcare and public-health assessment for possible rabies exposures and emphasizes that local or state health officials help assess risk. Use that guidance to design routing—not to let intake staff diagnose an infection, determine rabies or tetanus risk, recommend treatment, or decide whether post-exposure prophylaxis is required.

Reported breed

Preserve the identifier and its source

If a caller, report, veterinary record, license, owner, or other source identifies a breed, record it as reported and name the source. Do not infer breed from appearance or use a breed label to decide temperament, dangerousness, fault, notice, causation, liability, or case value.

Reporting and animal status

Local requirements are not universal

Ask whether and where a report was already made, record the report number and issuing source, and route local questions for authorized review. Do not promise that a report is required or unnecessary, that a particular quarantine or observation rule applies, or that vaccination status resolves medical or legal questions.

Official sources for workflow design

Adapt the form through authorized review

CDC dog bite guidance

The CDC's public guidance on staying healthy around dogs describes immediate safety and care considerations and points readers to local animal-control or police reporting guidance. It supports safety routing and useful animal and vaccination fields—not a legal-liability rule or instruction to contact an owner or potentially adverse person.

CDC rabies assessment guidance

CDC guidance on when to seek care for rabies and its clinical overview support prompt healthcare and public-health consultation, especially for severe exposures. Intake staff should route; qualified professionals and health officials assess risk and care.

CDC clinical wound guidance

CDC's clinical guidance for wound management to prevent tetanus classifies animal bites as dirty or major wounds for clinical assessment. It supports prompt clinical routing—not intake staff deciding vaccination, antibiotic, or treatment needs.

Public-health field example

The Los Angeles County Department of Public Health Animal Bite Reporting Form illustrates neutral victim, event, injury, treatment, owner, animal, and vaccination-status fields. It is one county's reporting form—not a national intake standard or universal reporting rule.

Prospective-client and intake boundaries

The ABA Model Rule 1.18 commentary discusses limiting an initial consultation to information reasonably necessary for the representation decision. The ABA Formal Opinion 506 discusses supervised nonlawyer intake and reserving legal judgment for lawyers. Local ethics and unauthorized-practice rules control.

Confidentiality and data minimization

ABA Model Rule 1.6 addresses safeguards for client information, while the FTC's Start with Security recommends collecting only needed data, retaining it for a legitimate need, and limiting access. For prospective-client data, apply Rule 1.18 and local rules. These sources are not a security, privacy, or compliance safe harbor.

These sources guide safety routing, neutral field design, supervision, and data minimization. They do not supply the liability rules, local reporting or animal-control requirements, quarantine decisions, medical conclusions, filing deadlines, preservation instructions, coverage analysis, conflict clearance, valuation, or case-acceptance criteria for a particular matter.

Frequently asked questions

Building a reliable dog bite intake form

What should a dog bite intake form collect first?

Start with safe contact information, the people and organizations needed for opening controls, the incident date and location, a short neutral account in the person's own words, the reported animal and owner or handler details, a reported injury and care snapshot, whether an agency report or evidence source may exist, and an assigned next action. Detailed records and insurance follow-up should wait until the firm's approved conflict process and an authorized reviewer determine what is reasonably necessary.

What animal and owner details belong in dog bite intake?

Record only what the source reports or what an identified record shows, such as the animal's name, general description, size, age, sex, reported breed, leash or enclosure status, and the reported owner, keeper, handler, or property contact. Keep the source and status of each detail visible, and do not treat breed or ownership information as a conclusion about danger, fault, control, or legal responsibility.

How should unknown dog bite facts be recorded?

Offer explicit confirmed, reported, disputed, unknown, and not-yet-obtained options rather than forcing an estimate. Track who supplied each detail and route material gaps for authorized follow-up so assumptions about the animal, owner, vaccination history, prior incidents, reporting, or insurance do not become conclusions.

What possible records and evidence sources should dog bite intake identify?

Inventory what may exist, who may control it, where it may be located, and its current status. Depending on the reported facts, possible sources can include animal-control or police reports, vaccination or veterinary records, licensing information, photographs, video, witness details, prior complaint records, property or lease records, communications, damaged clothing, and treatment records. An authorized reviewer should decide what the firm may request or collect through its approved process.

Should a dog bite intake form give medical or rabies-treatment advice?

No. Intake should not diagnose an injury, decide whether a person needs rabies or tetanus treatment, or delay care. It can use firm-approved safety routing that directs urgent concerns to emergency services, qualified healthcare professionals, and the appropriate local public-health or animal-control authority, while recording what the person reports about care and agency contact.

Does submitting a dog bite intake form create an attorney-client relationship?

A form should not promise or imply representation. Use firm-approved, jurisdiction-appropriate notices and keep the matter labeled as prospective-client work until the firm's authorized engagement requirements are complete.

Turn the worksheet into accountable intake

Keep animal, owner, report, evidence-source, review, and handoff details in one workflow.

ClaimVela helps PI firms receive inquiries, assign ownership, collect structured dog bite and animal attack facts and documents, prepare attorney review, communicate securely, and carry retained matters forward without rebuilding the record. Attorneys remain responsible for conflicts, medical and public-health routing policy, legal judgment, deadlines, qualification, and every representation decision.

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