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The Bernstein Approach
 

Dog Attacks

Step 2 of 3

Please tell us more about the injured person:

Injured person's first name: required field
Injured person's last name: required field
Address:
City:
State:
Zip:
Area code & phone number:
 - -
  Home Work Mobile
Age:
Gender: Male Female
______________________________

Please tell us about the dog attack:
Date of dog attack:
Location of dog attack - City:
Location of dog attack - State:
Brief description of the dog attack:
Do you know dog owner's name? Yes No
Do you know dog owner's address? Yes No
Does the dog owner rent or own a home?
Rent Own Unsure
______________________________

Please tell us about the injury:
Number of puncture wounds?
What parts of the victim's body did the dog bite?
Brief description of the injury:
Did victim get medical treatment? Yes No
How many stitches did victim get?
Did the victim need rabies shots? Yes No
Does the victim need surgery or further medical treatment?
Yes No Unsure
If yes, please describe additional treatment:
   

required field = Required Why?

 
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