Confinement Vaccination Report

After the 10 day confinement period has been completed, please promptly complete the confinement/vaccination report below by supplying the required information. The Health District will contact the veterinary office and verify the rabies vaccination is current. If the vaccination in not current or there is no record available you will be required to schedule an appointment at your veterinarian for rabies vaccination and provide documentation. It is important for this process to be completed in a timely manner because the Health District must be able to advise the person bitten/scratched/exposed of their risk of rabies.

Download Confinement Vaccination Form.

* denotes required field

Form:

Date of Bite/Scratch/Exposure: *

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ID#: *

Animal Name: *

Color: *

Breed: *

Dog License (optional):

Year:

Statement of Owner Responsibility

My: DogCatFerretOther Animal:

Was alive and in good health and in my possession as of: *

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(date at least 10 days past date of incident) and is current on rabies vaccine administered by a licensed veterinarian.

Veterinary Clinic Information:

Name: *

Name on Account: *

Phone: *

Address: *

City: * Zip: *

Vaccination Information:

Vaccination #: *

Vaccination type: *

Date Administered: *

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Owner Information:

Name: *

Phone: *

Email: *