Diagnostic Request

Submit Diagnostic Request To State BioLab Program

Contact Info

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

ZIP Code:

Phone Number:

Email:

User Group:

Problem You Are Reporting

What Town Is The Problem Within:

Description Of Problem:

Host Plant:

Date Problem Appeared/First Noticed:

Is The Problem Getting Worse:

Yes - Progressing Rapidly

Yes - Progressing Slowly

Have You Used Pesticides Or Herbicides Recently (Last Two Years):

Yes

What Types Of Pesticides Or Herbicides Were Used:

Have You Done Any Cultural Practices Recently:

Yes

What Types Of Cultural Practices (This Can Include Things Like Pruning, Mulching, Transplanting):

Affected Areas:

Buds

Branches

Leaves

Fruit/seed

Roots

Stem

Other:

Symptoms:

Discolored Foliage

Cankers

Decay/Rot

Defoliation

Dieback

Epicormic growth

Galls

Leaf spots

Other:

Symptom Distribution:

Top

Middle

Bottom

Scattered

Previous season's growth

Current season's growth

Location Type:

Garden

Nursery

Orchard

Forest

Plantation

Greenhouse

Household

Lawn

Other:

Soil Type:

Clay

Loamy

Sandy

Well drained

Poorly drained

Aspect:

North

South

East

West

Sending In A Sample?

Yes

Sending In Photos?

Yes

Date Sample Collected:

Date Sample Mailed:

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