Plant Sample Submission Form Plant Diagnostic Form Name First Last Business Street Address City, State, Zip Phone Email Date sample was collected MM slash DD slash YYYY Service requested Plant problem diagnosis Plant/weed identification Plant common and/or scientific name Cultivar Description of problemSypmtoms Abnormal growth Browning Leaf drop Rot Stunting Tip dieback Wilting Yellowing Location of Plant(s) Greenhouse Farm Indoor/house plant Lawn/yard Nursery Orchard Parts Affected Entire plant Fruits or seeds Flowers Leaves Roots Stems/trunk Irrigation Drip/soaker hose Hose/watering can Sprinkler/overhead Rain only Exposure Full sun Partial sun Shade Drainage Good Fair Poor Distribution of Problem Entire planting Edge of planting Group of plants Scattered plants Uniform Sunny areas Shady areas Wet areas Distribution on Plant Upper canopy Lower canopy Inner canopy Outer canopy CommentsThis field is for validation purposes and should be left unchanged.