AGGRESSION INCIDENT REPORT
Please review this entire questionnaire first, then go back and answer the questions as thoroughly as possible. Please return the questionnaire before the appointment if possible. Otherwise please have it with you at time of the appointment. Please, ask those who were present for input as well.
Date of Incident*
Location of Incident*
Who was present during the incident?*
Me/Family/Close Friends
Guests/Workers/Strangers
Vet/Vet Assistant
Groomer/Pet Sitter/Boarder
Were other animals were present? *
Yes
No
Was your animal on leash? *
Yes
No
If so, who was holding the leash?*
Was your animal in a cage/run?*
Yes
No
What preceded the incident? *
Had your pet been sick prior to the incident? *
Yes
No
Did your pet give any warning signals? Explain.*
Was there a bite? If not skip to 21.*
Yes
No
What location on the body was the bite?*
Did the bite cause bruising?*
Yes
No
Was there bleeding (torn skin)?*
Yes
No
Were there multiple puncture wounds? *
Yes
No
Was there a puncture wound?*
Yes
No
Did the pet bite not letting go?*
Yes
No
How did the incident end?*
What happened right after the incident?*
If there was a bite, was medical help sought? *
Yes
No
If there was a bite, was it reported?*
Yes
No
Yes
No
Is there anything else you feel we should know?