Name ___________________________________________________ Phone # _______________

Address ___________________________________________________________________________

City ___________________________ State ___________ Zip ___________________

Instructions: Fill out all information as completely as possible. This is to aid in diagnosing the problem your lawn is experiencing.

Brief description of problem ___________________________________________________________

__________________________________________________________________________________

When did you notice the problem (approximate date?) _________________________

Has the problem occurred before? _________ when? ________________________________________

Is the problem located in: full sun? semi-shade? full shade?

Is the semi-shade or full shade created by trees? shrubs? building? other?

Is the problem site near drive? road? ledge? septic system or any other feature?

Explain ____________________________________________________________________________

How near ______feet. Are deicing salts used? _______ Is the problem site near a pool? ____________

Is the pool water drained into the area? __________ How often? ___________ Is the problem site level?

On a slope? Degree of slope? __________ Does the slope face North? South? East? West?

Is the problem site excessively wet? dry? If wet, is a body of water nearby? (i.e. brook, swamp, pond)? ____________________________________

When was the last time the soil was tested? ______________________________

Results, if known pH _________ Ca _________ Mg _________ P _________ K _________

Was the lawn limed recently? ____________________ When? ________________________________

Rate of application (lbs/1000 sq ft) ___________________________

Do you fertilize the lawn? ____________________

Kind of fertilizer (brand name)? _________________________________________________________

The fertilizer grade (5-10-10, 10-6-4, 21-6-3 etc.)? ______________________

Rate of application (lbs/1000 sq ft)? __________________________________

Number of times a year fertilizer applied? ______________________________

Give the approximate date(s) of application ______________________________

Was an herbicide or weed and feed fertilizer used? _________________________

Rate of application (lbs/sq ft, etc.) ______________________________________

Date of application(s) _________ Were any insecticides or fungicides used? _________________

What kind? ____________________________________________________

Rate of application (lbs/1000 sq ft; oz/gal, etc) __________________________________________

Is the lawn watered? __________ How often? __________ Time of day watered _______________

Length of time sprinkler was at one location ________________________

Was the lawn seeded or sodded within the past year? ______________________________________

If new, when? _________ from seed? from sod? Send in label if available.

How was the site prepared prior to sodding or seeding (include depth of tilling, fertilizer or lime applied, herbicide, insecticide or fungicide used, etc.)? ____________________________________________

_________________________________________________________________________________

In addition to the above information submit a sod sample for examination. Take a 6" x 6" x 3" deep sod sample at the edge of the problem area. Include the root system in the sample. Place the sample in a plastic bag and ship in a STURDY box 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.