Get Tick Submission Form - Plainville - Southington Regional Health ...

Filling out the Tick Submission Form is a straightforward process that ensures proper reporting and testing of ticks. This guide will walk you through each step to complete the form correctly.

Follow the steps to accurately complete the Tick Submission Form.

1. Click ‘Get Form’ button to access the Tick Submission Form.
2. Enter the date in the designated section at the top of the form.
3. Fill in the information about the submitting health department. Write the name 'Plainville-Southington Regional Health District' in the name field and the address as '196 North Main Street, Southington, CT, 06489'. Use the email address 'gleicherl@southington.org' and the telephone number '860-276-6275'.
4. Indicate if the tick was removed from a pet by selecting 'Y' for yes or 'N' for no. If it was from a pet, please provide the pet species, name, and age.
5. Complete the personal details of the person who was bitten by the tick. Input their name, address, telephone number, email, age, and gender (mark 'M' for male or 'F' for female). If applicable, include the name of their guardian.
6. Specify the date when the tick was removed and identify the part of the body where the tick was found.
7. Indicate the town in which the tick was acquired.
8. Once all information is filled in, review for accuracy. Save your changes, download the completed form, print it, or share it as necessary.

Complete the Tick Submission Form online today for proper reporting and testing.