Download Plant Problem Diagnostic Form

CLIENT
Name:
Business name:
Address:
5880 Glenwood
Boise, Idaho 83714
208.287.5900
PLANT PROBLEM
City/State/Zip:
Phone:
Email:
DATE RECEIVED:
Please fill in form completely. Check all that apply. Missing information may delay response.
Plant Problem
Plant name:
Number of plant(s) affected:
Age of plant(s):
Did you plant it? yes no
How long have you cared for this
plant?
When did you first notice symptoms?
Part(s) affected:
Entire Plant
Leaves/Needles
Roots
Branches
Site type:
Slope/Berm
Low area
Soil type:
Clay
Sand
Gravel
Flowers
Fruits/Seeds
Stems
Trunk
Level
Caliche/Hardpan
Loam
Other
Symptoms:
Dead areas
Leaf/Needle drop
Canker/Gall
Rot
Tips/Edges browning
Symptom distribution:
Top of plant
Middle
Bottom
Interior of tree
Location of plant(s)
Field/Crop
Pasture
Orchard
Lawn
Near roadside/
driveway/sidewalk
Plant located in:
Sun
Shade
Wilted
Yellowed
Leaf spots
Stunted
North/East side
South/West side
Entire plant
Branch tips only
Landscape
Vegetable
garden
Indoors
Near rain gutter
Next to
house/building
Sun & Shade
Mulch:
Against stem: yes
Type of mulch:
Water source:
Sprinkler
Flood
Other
no
Hose
Drip
Irrigation:
Minutes per day:
Days per week:
Have chemicals been applied to the area?
yes no
Name of product applied:
Date applied:
Landscape service: yes no
Company Name:
Continue onto Other Side
Briefly describe the problem:
Draw a picture of the affected plant’s location. Please indicate orientation (north, south, east,
west), structures, sidewalks, etc.
OFFICE USE ONLY
Notes:
Problem identified as:
Date resolved:
Researched by:
Contacted by:
Contact type:
Recommendations for control:
Face to face
Email
Phone/Voicemail
# of Adult Clients and Gender:
Male
# of Children and Gender:
Male
References used:
Page #:
Computer entry:
Female
Female