Virginia Cooperative Extension
Virginia Cooperative Extension
Virginia Tech • Virginia State University

Henrico County Office
8600 Dixon Powers Drive
PO Box 90775
Henrico, VA 23273-0775
804-501-5160
Fax: 804-501-5169

Diagnostic Form

Complete the fields that apply to your plant, insect or other diagnostic request. Fields marked “check all that apply” allow more than one selection.

Contact Information

This request is for
May we add you to our email mailing list?

Plant Identification

Type of plant Select one
Are berries or flowers present?
Is there a problem with this plant?

If yes, complete the Plant Problem section below.

Insect or Other Identification

How many did you find?
Is it causing a problem?

Plant Problem Details

Plant part affected Check all that apply
General appearance Check all that apply
Disease distribution Check all that apply
Did symptoms occur in previous years?
Severity of problem
If lawn, how much of the area is affected?
Size of total planting
Where is the plant located? Check all that apply
Type of exposure Check all that apply
Number of years at the present site
Has the plant been irrigated?
Has the plant been mulched?
If the plant is woody
Canopy condition
Condition of trunk
Root damage or soil disturbance Check all that apply

Laboratory and Office Use

Submitted to the following lab Check all that apply
Integrated pest management recommendation?

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