Name ___________________________________________________ Phone # _______________

Address ___________________________________________________________________________

City ___________________________ State ___________ Zip ___________________

Instructions: Please fill out as completely as possible. This is to aid in diagnosing the problem your houseplant is experiencing.

Plant name (botanical and/or common) ___________________________________________________

Brief description of problem ____________________________________________________________

___________________________________________________________________________________

When was the problem first observed? ____________________________________________________

What, if anything, was done to control the problem? ________________________________

__________________________________________________________________________

What product was used (name and rate)? _________________________________________

Is the plant a recent purchase or gift? ______________________________

From a florist? ______ Nursery? ______ Supermarket? ______

Other? ____________________________________________________________________

How long has the plant been in its present location? __________________________________________

How big is the plant? _______________________ feet or inches

How often is the plant watered? __________________________________________________________

How much water is applied? ____________________________________________________

How is the plant watered? Bottom? ________ Top? ________

Does the plant sit in water for an extended period of time? ____________________________

How long? __________________________________________________________________

How often do you fertilizer the plant? ______________________________________________________

How much fertilizer is applied per application? _____________________________________

What kind of fertilizer is used? __________________________________________________

Was the plant repotted recently? _________________________

Size of the original container? Diameter ________ Depth ________

Size of the present container? Diameter ________ Depth ________

What is the container made of? Plastic________ Clay ________ Unglazed ________

Glazed ________ Other _________________________________________

Does the container have drainage holes? Bottom ________ Side _________

What is the soil texture? Clayey ________ sandy ________ other? _______________

Is the plant growing in natural light? ___________________

What is the exposure? North ________ South ________ East ________ West ________

How close is the window? ________ feet. Directly in front ______ to the side ______

Are trees or shrubs blocking direct entry of light? ______________

Does the window have curtains that filter the light? ______________

Is the plant growing in artificial light? __________________________________

How many hours per day? ________ wattage per bulb ________ # of bulbs ________

What kind of bulbs? Fluorescent ________ Incandescent ________

How high is the light source above the plant? _________________________________

Was the plant outside recently? _________ From_____________to_____________

What kind of exposure? Shade ________ Semi-shade ________ Full sun ________

In addition to the above information submit a sample of the affected plant. Include in the sample diseased and healthy plant parts. Enclose the sample in a plastic bag and ship in a STURDY box. Mail at the beginning of the week to shorten the time in transit. Fresh material is required for an accurate diagnosis. Mail to your local extension office or the Home & Garden Education Center, 1380 Storrs Road, U-115, Storrs, CT, O6269-4115.

Date Received ________/________/________

Diagnosis ________________________________________________________

By whom ________________________________________________________

Recommendations ___________________________________________________________________

__________________________________________________________________________________

Prepared by: Edmond L. Marrotte, Consumer Horticulturist, Home & Garden Education Center, Revised 7/98

This information was developed for conditions in the Northeast. Use in other geographical areas may be inappropriate.

The information in this material is for educational purposes. The recommendations contained are based on the best available knowledge at the time of printing. Any reference to commercial products, trade or brand names is for information only, and no endorsement or approval is intended. The Cooperative Extension system does not guarantee or warrant the standard of any product referenced or imply approval of the product to the exclusion of others which also may be available.All agrochemicals/pesticides listed are registered for suggested uses in accordance with federal and Connecticut state laws and regulations as of the date of printing. If the information does not agree with current labeling, follow the label instructions. The label is the law.Warning! Agrochemicals/pesticides are dangerous. Read and follow all instructions and safety precautions on labels. Carefully handle and store agrochemicals/pesticides in originally labeled containers immediately in a safe manner and place. Contact the Connecticut Department of Environmental Protection for current regulations.The user of this information assumes all risks for personal injury or property damage.Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture. Kirklyn M. Kerr, Director, Cooperative Extension System, The University of Connecticut, Storrs. The Connecticut Cooperative Extension System offers its programs to persons regardless of race, color, national origin, sex, age or disability and is an equal opportunity employer.