Diseased Wildlife Report

* Species

Species is a required field.

Date of Observation

* Name (First)

First name is a required field.

* (Last)

Last name is a required field.

* Phone

Phone is a required field.

Address

City

State

Zip

Landowner name

Phone

Club/Property Name

Location

* Lat

Latitude is a required field.

* Long

Longitude is a required field.

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Age

Sex

Did the deer exhibit any of the following signs:

Which of these best describes the condition of the infirmed animal:

Brief description of other symptoms (if not listed above):

Describe the current location of the deer:

Additional Comments: