Purdue Plant Diagnostic Lab — Plant Submission Form

Fill out by hand and mail with your sample, or fill in on-screen and print.

Submitter Information

First name

Last name

Business / organization

Address

City

State

Zip

County

Phone

Plant / host

Cultivar / variety

Field ID

Date planted

Approximate age of plant

Date first noticed problem

Describe the problem Tentative diagnosis / ID or main concern

Full sun Partial shade Full shade Unknown

Mail this form along with your physical sample to the Purdue Plant Diagnostic Lab.