Animal Cruelty/Neglect Report Form

Have you filed a report with another agency? * Required
- Yes
- No
Which one?: * Required
Date of incident * Required
MM slash DD slash YYYY
Have you seen the animal(s) since the incident? * Required
- Yes
- No
Date of last seen animal(s) since the incident * Required
MM slash DD slash YYYY
Time of last seen animal(s) since the incident * Required

: Hours

Minutes

AM/PM AM/PM
Location of incident: * Required
Be as specific as possible.
Type of animal(s): * Required
- Dog
- Cat
* Required
Color Breed Size
Skin/coat condition: * Required
- Hair loss
- Mange
- Sores
- Fleas/ticks
- Matting
- Other
Other * Required
Physical condition: * Required
- Underweight
- Healthy
- Overweight
- Other
Other
Injury:
- Shot
- Stabbed
- Cut
- Beaten
- Bleeding
- Over-heated
- Eye/ear infection
- Embedded collar
- Unable to stand
- Other
Other
Where is the animal injured:
- Head
- Back
- Tail
- Leg
- Other
Other * Required
Shelter: * Required
- None
- Available
Please describe: * Required
Water: * Required
- None
- Available
Please describe: * Required
Food: * Required
- None
- Available
- Spoiled
Sanitation: * Required
- Feces
- Wet/muddy
- Trash
- Toxic waste
- Other
Other: * Required
Summary of incident/concern: * Required
Your Information:
*Please know that your personal information is kept confidential. In the event we have additional questions or need to follow up about a concern, we will need your contact information to do so.
Your Information: * Required
- I would prefer to remain anonymous
- I will include my contact information
Name * Required
First Last
Address * Required
Street Address City State ZIP Code
Phone (primary) * Required
Phone (secondary)
Email * Required
Animal Owner's/Suspect's Information:
Animal Owner/Suspect Information: * Required
- Unknown
- I know the Animal Owner's/ Suspect's contact Information
Name * Required
First Last
Relationship to animal owner/suspect * Required
Address * Required
Street Address City State ZIP Code
Phone (primary)
Phone (secondary)
Email
Vehicle Description
Make:
Model:
Color:
License Plate:
Other:
* Required
- I do not wish to be contacted.
- I would like to hear from a Humane Officer about this report.

Give Us a Call:

Office Hours:

Viewing Hours:

Animal Cruelty/Neglect Report Form

Your Information:

Animal Owner's/Suspect's Information:

262-782-9261

262-782-3356

Elmbrookhs@ebhs.org

Color	Breed	Size