Utah Screwworm Wildlife Suspect Form
I am:
*
General Public
Wildlife Organization/Rehab
Other
Contact Information (Optional)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Animal Information
Species
*
Adult or Juvenile?
*
Adult
Juvenile
Unsure
Alive or Dead?
*
Alive
Dead
Approximate Location
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Sample Submission
Were larvae collected?
Yes
No
Do you need assistance submitting larvae for confirmation?
Yes
No
If larvae were submitted, which lab were they submitted to?
Submission Date
-
Month
-
Day
Year
Date
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