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Plant Problem Form

Contact Information ( * indicates required fields)
 
*Name:
 
*Street Address:
 
*City:
 
*State:
 
*County:
 
*Zip:
 
*Daytime Phone:
 
*Email:
  Plant Information  
 
*Plant:
 
Variety:
 
*Describe Problem:
 
When did symptoms first appear?:
 
Has the problem occurred before?:
 Yes spacer No spacer When?:
 
Plant Part Affected:
 Leaves Roots Stems/Branches Flowers
 
Symptoms
  
 
Yellowing:
 Interveinal spacer General spacer Marginal
 
Browning:
 Interveinal spacer General spacer Marginal
    Wilting Distortion Mottling Leaf Spots
 
Other:
  Type of Planting  
 

Field spacer Forest spacer Garden spacer Golf Course spacer Greenhouse
Indoor/Housespacer Nursery spacer Orchard spacer Plantation spacer Vineyard
Yard spacer Other:

  Problem Area  
 
General spacer Scattered Plants spacer Dry Areas spacer Wet Areas
Shaded Areas spacer Sunny Areas spacer High Areas spacer Low Areas
Foundation spacer Next to Drive or Road spacer Near Vents/Fans
     
  Soil Type spacer Soil Moisture
 
Sandyspacer Clay spacer Loam
Excessive spacer Adequate spacer Deficient
     
  Terrain spacer Drainage
 
Sloped spacer Level spacer Low
Good spacer Moderate spacer Poorspacer
  Size of Planting   Extent of Problem
 
Acres
Square Feet
Number of Plants
  Percentage of Plants Affected
( or )spacer
Number of Plants Affecteed
  Trees/Shrubs
 
 
Approximate Age:
 
Height:
 
How long in present location?:
  Chemicals Applied This Season & Previous Season (include materials, rates & dates)
 
Fertilizer:
 
Fungicide:
 
Insecticide:
 
Herbicide:
 
Nematicide: 
  Disturbances
 
   High Winds spacer Frost spacer Recent Hail spacer Nearby Construction
Gas or Sewer Lines spacer Excavation Ft. Away spacer None
Other:
  Turf-grass
 
Grass Killed 
No Distinct Pattern; Irregular Areas spacer
 
Grass Thinned 
Definite Pattern to Affected Areas spacer
  Additional Comments
 

 
   spacer
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Last modified Friday, April 7, 2006 15:59