Name ___________________________________________________ Phone # _______________

Address ___________________________________________________________________________

City ___________________________ State ___________ Zip ___________________

Instructions: Please fill out both sides as completely as possible. This is to aid in diagnosing the problem your vegetable plant is experiencing.

Plant name ____________________________ Variety __________________________

Brief description of problem ____________________________________________________________

When was the problem noticed? __________________ What part of the plant is affected? ___________

Is just one type or variety of plant affected (ie: only Big Boy tomato)? ___________________________

Has the problem occurred before? _________ When? ________________________________________

Was anything done to control the problem? ______ if yes, what? _______________________________

Name of any insecticide and/or fungicide used _________________________ Type of insecticide and/or fungicide (15% WP, 5% dust, 50% E, etc) ____________________________

number of times used? _________________ Days between applications __________________________

Was the plant grown from seed? _________ Planting date _____________________________________

Transplants raised?_____ Purchased?_____ Is the plant growing in a container? ______ Garden? ____

If container, size of container. Diameter _____________ Depth ______________

Location of drainage holes (side, bottom, etc) _______________________________________________

Type of soil? _______________________ Is the container watered? _____________ Was any fertilizer or manure applied to the garden or container this season? _______________________

If yes, what kind (chicken manure, 5-10-10, etc)? ________________________________________

What was the rate of application (bu/100 sq ft or lbs/100 sq ft, etc)? __________________________

When was it applied (spring, fall, prior to tilling, etc)? _____________________________________

Was any lime applied? __________ Rate of application lbs/1000 sq ft _____________

When? ______________________ Type: hydrated? agricultural? Other ___________________

Is mulch used? ________________ When was it applied? ______________________________________

If an organic mulch, how thick is it? ____________________________ If grass clippings, was the lawn treated with an herbicide or weed and feed fertilizer? ___________

When? _______________________________________________________________________________

If yes, name and rate of application? _______________________________________________________

Was the soil tested recently? _____________________

Test results, if known? pH _________ Ca _________ Mg _________ P _________ K _________

Is the garden side in full sun? Shade? Hours of sun per day _________________

Does the soil stay wet for a long period of time after a rain? _____________________

How long? ______________ Is the garden irrigated? _________________

How frequently? __________________ Method used (watering can, hand held hose, sprinkler, etc)? ________________________________ Was the site always a vegetable garden? ___________________

If not, what was it before (lawn, empty lot, cornfield, etc)? _____________________________________

Were any weed killers used in the garden or in the immediate area? ______________________________

What kind? ________________________ Rate of application ___________________________________

Was the garden sprayer ever used to apply weed killers? _______________________________________

What kind? _____________________ When? _________________

How big is the garden? ___________________________________

Were wood ashes put in the garden? _________________________

How much? ____________________________________________

In addition to the above information submit a sample of the affected plant or fruit. Place 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.