Personal Consultation Form "*" indicates required fields Date* MM slash DD slash YYYY Name* First Last Email* Enter Email Confirm Email Address* City State State/Province/RegionAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Type of Consultation*Select OneActive TreatmentPrevention TreatmentBothNot SureType of Plants You Have*Pests You Suspect*Choose all that apply Thrips Spider Mites Mealybugs Root Mealybugs Scale Root Scale Aphids Fungus Gnats Other Pests, Other*Please Specify Severity of Infestation*Select OneOnly Seeing DamageSeeing LarvaeSeeing AdultsSeeing Both Larvae and Adults# of Plants Treating*Please enter a number from 0 to 1000.Average Size of Plants*Select OneSmall/2-6 Inch PotsMedium/8-10 Inch PotsLarge/12+ Inch PotsHumidity*Select OneAmbient Humidity60%+ HumidityBothSet Up*Choose all that apply Clustered Spread Out Both In a Cabinet Type of Medium*Choose all that apply Soil Moss Pon LECA Stratum Perlite Vermiculite Water Other Medium, Other*Please Specify Treatment History*Choose all that apply I’ve used insecticidal sprays I’ve used systemic granules I’ve used horticultural sprays I’ve used neem oil I’ve used pesticide sprays I’ve used beneficial insects No treatment history What brand of Insecticidal Spray did you use and when was the last time it was used?*What brand of Systemic Granules did you use and when was the last time it was used?*What brand of Horticultural Spray did you use and when was the last time it was used?*What brand of Neem Oil did you use and when was the last time it was used?*What brand of Pesticide Spray did you use and when was the last time it was used?*What Beneficial Insects did you use and when was your last release?*Budget Considerations*Select OneUnder $50Under $75Under $100Under $150CustomCustom Budget Amount*Plants/Damage Image Upload Drop files here or Select files Max. file size: 64 MB. Additional NotesPhoneThis field is for validation purposes and should be left unchanged.
