IPM DIAGNOSTICS LABORATORY

Specimen Description Form


Note: All information items not marked optional must be fully completed to ensure proper diagnosis.

Your name:  (only required if you you do not
e-mail this form or submit it from someone else's computer.)


ID Number    Date of Collection 



                     Estate of Collection 

                                   Island 


CLIENT INFORMATION (optional)

CLIENT'S NAME
   First Name    Last Name 

   Address 
           
           
 Telephone  




PLANT PEST INFORMATION

HOST PLANT  
(Give scientific name only if common name is ambiguous)

LEVEL OF INFESTATION - Among hosts   %
                       Within hosts  %


LOCATION OF PEST ON HOST
             Leaf       Stem     Root 
             Flower     Shoot    Bud  
             Fruit  

Symptoms on plant which are not obvious when examining the specimen



Any other relevant information:


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