OHEP Disease Reporting Form

County of San Diego - Epidemiology and Immunization Services Branch


Please complete the form below to voluntarily report a single case of another disease, condition or syndrome in animals to the One Health Epidemiology Program (OHEP).

 

Reporting Veterinarian or Other Contact

 

Please include first and last name.

 
 
 
Phone
 
 

 

Animal Information

 
 

Please enter "N/A" if not applicable.

 

Identifiers can include the animal's tag # or microchip #. Please provide a description of the animal if there is no name or other identifiers (ex: black cat with white paws).

 
 
 
 
 

 

Animal History

 
 
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 
 

Please include vaccine information if applicable.

 
 
Drop your files here
 

Only enter a date if applicable.

 
mm/dd/yyyy
 

 

Animal Owner (Optional)

 

Please include first and last name(s).

 
 
Phone
 
 

 

Animal Location (Optional)

Please complete this section if the animal location is different from the owner location.

 

Please specify where the animal is located.

 
 
Phone
 

Thank you for your time!