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(847) 459-7535
2051 Waukegan Road, Bannockburn, IL 60015

Home
Who We Are
Pet Owners
Specialties
Veterinary Professionals
Contact
- Appointment Request
Blog

Appointment Request

Refer a Patient

(847) 459-7535 / 2051 Waukegan Road, Bannockburn, IL 60015

24 Hour Emergency & Critical Care

Current Wait Time for ER: Minutes

Please call us before coming in to discuss your pet's current condition.

Get in Line for the ER

VSC Bite Form

Animal Bite Report

A veterinarian should complete this report to the best of their ability. All questions marked as "required" are required to submit the form. If information is unknown, please answer or write in UNKNOWN.

Name of VSC employee reporting bite/scratch(Required)

First Last

VSC employee email(Required)

You will receive a copy of this bite report.

Today's submission is best described as:(Required)

Day 1 (first examination date of biter/bitee)

Day 5

Day 10 (final/release date)

Day 30 (final/release date)

6 month (final/release date)

Other

Examined patient is(Required)

Alive

Deceased on arrival

Euthanized

Name of Examined Patient(Required)

First Last

Examined Patient Species(Required)

Canine

Feline

Examined Patient Sex(Required)

Male

Female

Examined Patient Altered?(Required)

Yes

Examined Patient Breed(Required)

Examined Patient Color(Required)

Examined Patient Age(Required)

Examined Patient is best described as the:(Required)

Aggressor (bit)

Victim (was bitten)

Both

Examined Patient have CURRENT rabies vaccination?(Required)

Yes, non-expired

Examined Patient last rabies vaccination administration date(Required)

MM slash DD slash YYYY

Rabies tag number if known

Please answer the following general questions describing the bite.

You are reporting a bite/scratch that is:(Required)

Animal to human

Animal to animal

Both

Does victim animal have current rabies vaccination?(Required)

Yes

Unknown

Today's Date(Required)

Date of Bite(Required)

City where bite occured.(Required)

Describe what happened and how the bite occured.(Required)

Please be as detailed as possible (e.g., was the animal approached, animal has a collar, known animal, animal's behavior leading up to the bite, any witnesses).

Select county where BITING ANIMAL lives. If unknown, select county where VICTIM lives.(Required)

Upon submission, selected county will automatically receive a copy of this bite report.

Name of missing county.(Required)

This bite report will be forwarded to the appropriate county and added to our list.

Bite Victim Information

Name of person bitten.(Required)

First Last

Name of owner of pet that was bitten.(Required)

First Last

Name of pet bitten.(Required)

First Last

Description of VICTIM animal (i.e., type, color, breed, etc.)(Required)

Example: Gray/White, DSH, M/N, 10yr

Address of person bitten.(Required)

Street Address Address Line 2 City State ZIP Code

Address of pet bitten.(Required)

Street Address Address Line 2 City State ZIP Code

Date of Birth of person bitten. (if known)

Date of Birth of pet bitten.(Required)

Sex of person bitten.(Required)

Sex of pet bitten.(Required)

Home Phone of person bitten.(Required)

Home Phone of owner of pet bitten.

Email of person bitten.(Required)

A copy of this report will be sent to this email address.

Enter Email Confirm Email

Email of person bitten.(Required)

A copy of this report will be sent to this email address.

Enter Email Confirm Email

Email of owner of pet bitten.(Required)

A copy of this report will be sent to this email address.

Enter Email Confirm Email

Email of owner of pet bitten.(Required)

A copy of this report will be sent to this email address.

Enter Email Confirm Email

Type of Human Exposure(Required)

Bite

Scratch

Other

Type of Pet Exposure(Required)

Bite

Scratch

Other

Part(s) of human body bitten/scratched?(Required)

Part(s) of pet body bitten/scratched?(Required)

Severity of Human Exposure/injury(Required)

Minor

Moderate

Serious

Severity of Pet Exposure/injury(Required)

Minor

Moderate

Serious

Stitches required for bitten person?(Required)

Yes

Unknown

Stitches required for bitten pet?(Required)

Yes

Unknown

How much of the biting animal's information do we have?(Required)

All information (including owner name, address, phone, email, etc.)

Partial information

None, unknown domestic

None, wildlife

Does biting animal have current rabies vaccination?(Required)

Yes

Unknown

Please share any partial information (name, phone, address, etc.) we have about the biting animal, but bite report should be submitted to VICTIM's county.

Please explain why we do not have the biting animal's information.(Required)

For example, the biting animal was a racoon.

Biting Animal Information

Biting Animal Owner's Name(Required)

First Last

Biting Animal Owner's Phone Number(Required)

Biting Animal Owner's Address(Required)

Street Address Address Line 2 City State ZIP Code

Biting Animal Owner's Email(Required)

A copy of this report will be sent to this email address.

Enter Email Confirm Email

Name of Biting Animal(Required)

First

Biting Animal Type(Required)

Dog

Cat

Other

Biting Animal Sex(Required)

Description of BITING animal (i.e., type, color, breed, etc.)(Required)

Example: Gray/White, DSH, M/N, 10yr

Biting animal rabies vaccination date (if known)

Biting animal rabies tag number (if known)

Observation and Confinement Details

VSC Employee Acknowledgement(Required)

Client has been made aware that since their biting animal has a current rabies vaccination, owners of biting animals with current rabies vaccinations may be allowed to confine their biting animals at home for a 10-day period. If home confinement, the biting animal must be evaluated via phone on day 5 of confinement and an in-person examination on day 10. The subsequent phone evaluation and in-person exam may be performed by a primary care veterinarian or by one of the emergency doctors at Veterinary Specialty Center. Should the biting animal die or be euthanized during the home confinement and observation period, client has been made aware that they are legally obligated to immediately submit the animal's remains for laboratory testing of rabies at the their expense. **NO Rabies vaccination necessary.**

VSC Employee Acknowledgement(Required)

Client has been made aware that since their bitten animal has a current rabies vaccination and was bitten by a domesticated animal, no confinement or quarantine is required. **NO Rabies vaccination necessary.**

VSC Employee Acknowledgement(Required)

Client has been made aware that even though their bitten animal does NOT have a current rabies vaccination and was bitten by a domesticated animal, no confinement or quarantine is required. **NO Rabies vaccination necessary.**

VSC Employee Acknowledgement(Required)

Client has been made aware that since the biting animal does NOT have a current rabies vaccination, 10-day confinement/quarantine is required.

HOSPITALIZED PATIENTS:
For patients that are hospitalized and sick/recovering in our ER, ICU, or post-op Ward, the county understands that the isolative environment while only providing the necessities during an in-hospital rabies quarantine may be detrimental to their health. Therefore, a letter can be emailed to the county to allow for home confinement. If the patient is discharged prior to fulfilling the 10-day observation period, they will then need to isolate their pet in their home for the remainder of the isolation period. If applicable, the biting animal must be evaluated via phone on day 5 of home confinement (owner is responsible for calling and speaking with a VSC ER doctor) AND an in-person examination on day 10 (additional fees may apply). Should the biting animal die or be euthanized during the home confinement and observation period, client has been made aware that they are legally obligated to immediately submit the animal's remains for laboratory testing of rabies at the their expense. **DO NO VACCINATE for Rabies.**

If requesting home confinement, under the patient's most recent green clinical record, in the Vet Communication section, send the 'Rabies (domestic bites) Home Confinement Letter' email template in ezyVet. This template contains the email address of the appropriate county, which will need to be copy and pasted into the 'To' section of the email.

NON-HOSPITALIZED PATIENTS:
These patients are legally required to undergo an in-hospital quarantine. As Veterinary Specialty Center does not offer in-hospital quarantine services, the client will be responsible for coordinating an alternative facility, preferably through the assistant of the patient's primary care veterinarian. **DO NO VACCINATE for Rabies.**

VSC Employee Acknowledgement(Required)

Client has been made aware that since the involved animal was wildlife and their pet is currently vaccinated for rabies, 30-day confinement/quarantine is required.

HOSPITALIZED PATIENTS:
For patients that are hospitalized and sick/recovering in our ER, ICU, or post-op Ward, the county understands that the isolative environment while only providing the necessities during an in-hospital rabies quarantine may be detrimental to their health. Therefore, a letter can be emailed to the county to allow for home confinement. If the patient is discharged prior to fulfilling the 30-day observation period, they will then need to isolate their pet in their home for the remainder of the isolation period. The biting animal must then have an in-person examination on day 30 (additional fees may apply). Should the biting animal die or be euthanized during the home confinement and observation period, client has been made aware that they are legally obligated to immediately submit the animal's remains for laboratory testing of rabies at the their expense. **DO NO VACCINATE for Rabies.**

If requesting home confinement, under the patient's most recent green clinical record, in the Vet Communication section, send the 'Rabies (wildlife bites) Home Confinement Letter' email template in ezyVet. This template contains the email address of the appropriate county, which will need to be copy and pasted into the 'To' section of the email.

NON-HOSPITALIZED PATIENTS:
These patients are legally required to undergo an in-hospital quarantine. As Veterinary Specialty Center does not offer in-hospital quarantine services, the client will be responsible for coordinating an alternative facility, preferably through the assistant of the patient's primary care veterinarian. **DO NO VACCINATE for Rabies.**

VSC Employee Acknowledgement(Required)

Client has been made aware that since the involved animal was wildlife and their pet does NOT have a current rabies vaccination, 6-month confinement/quarantine is required.

HOSPITALIZED PATIENTS:
For patients that are hospitalized and sick/recovering in our ER, ICU, or post-op Ward, the county understands that the isolative environment while only providing the necessities during an in-hospital rabies quarantine may be detrimental to their health. Therefore, a letter can be emailed to the county to allow for home confinement. If the patient is discharged prior to fulfilling the 6-month observation period, they will then need to isolate their pet in their home for the remainder of the isolation period. The biting animal must then have an in-person examination on day 180 (additional fees may apply). Should the biting animal die or be euthanized during the home confinement and observation period, client has been made aware that they are legally obligated to immediately submit the animal's remains for laboratory testing of rabies at the their expense. **DO NO VACCINATE for Rabies.**

If requesting home confinement, use the 'Rabies Home Confinement' email template in ezyVet, which contains the email address of the appropriate county, which will need to be copy and pasted into the 'To' section of the email.

NON-HOSPITALIZED PATIENTS:
These patients are legally required to undergo an in-hospital quarantine. As Veterinary Specialty Center does not offer in-hospital quarantine services, the client will be responsible for coordinating an alternative facility, preferably through the assistant of the patient's primary care veterinarian. **DO NO VACCINATE for Rabies.**

VSC Employee Acknowledgement(Required)

Client has been made aware that if their animal died or was euthanized during the home confinement and observation period, client is legally obligated to immediately submit the animal's remains for laboratory testing of rabies at the their expense.

Is the biting animal being placed under rabies observation?(Required)

Yes

Unknown

Rabies observation will be conducted via:(Required)

Home Confinement

In Clinic/Hospital at Alternative Facility

Rabies observation initiated by: Veterinary Specialty Center

Veterinary Hospital/Clinic: Veterinary Specialty Center Phone: (847) 459-7535

Veterinary Hospital/Clinic: In Clinic/Hospital at Alternative Facility

FIRST Examination Date(Required)

Microchip # (if known)

Attending Veterinarian(Required)

e.g., Dr. Jane Doe

Consent(Required)

I, as the attending veterinarian, attest that this animal is not currently exhibiting any clinical signs consistent with rabies. Client is aware they are to continue with the animal's confinement until it has been physically examined and released on Day 10.

Consent(Required)

I, as the attending veterinarian, attest that this animal has been physically examined, is not currently exhibiting any clinical signs consistent with rabies, and is hereby released for the completion of the mandatory 10-day confinement and observation period.

Consent(Required)

Attending Veterinarian's Signature(Required)

Reporting Agency Name: Veterinary Specialty Center 2051 Waukegan Rd, Bannockburn, IL 60015 P. (847) 459-7535