Get the free TICK TEST REQUEST FORM JUNE 2011

TICK TEST REQUISITION (JUNE 2011) Gene, Inc. 795 San Antonio Rd Palo Alto, CA 94303 800/832-3200 Fax: 650/424-1196 www.igenex.com TO SEND A TICK: Place ticks (up to 20) in a small tube or plastic

How to fill out tick test request form

1. Start by gathering all the necessary information for the tick test request form. This may include personal details such as name, contact information, and address.
2. Next, identify the purpose of the tick test request form. Is it for a specific research study, medical diagnosis, or public health surveillance? Understanding the purpose will guide you in providing accurate information.
3. Fill in the required fields on the form, such as the date of the tick bite, the location where the tick was found, and any accompanying symptoms or reactions you may have experienced.
4. Provide details about the tick itself, such as its size, color, and whether it was attached to your body. If possible, take a clear photo of the tick to include with the form.
5. Indicate your preferred method of tick removal, whether it was done at home or by a healthcare professional. Include any relevant details about the removal process.
6. If you have been experiencing symptoms or complications after the tick bite, make sure to detail them accurately on the form. This can include fever, rash, joint pain, or any other noticeable changes in your health.
7. Finally, sign and date the form to confirm the accuracy of the information provided. If there are additional documents or samples required, such as blood samples or photographs, include them with the form as instructed.

Who needs a tick test request form?

1. Individuals who have been bitten by a tick and want to have it tested for diseases such as Lyme disease, Rocky Mountain spotted fever, or other tick-borne illnesses.
2. Healthcare professionals who suspect a patient may have contracted a tick-borne disease and require testing to confirm the diagnosis.
3. Research institutions or public health organizations conducting studies or surveillance on tick-borne diseases may also require tick test request forms from individuals who have encountered ticks.

In conclusion, filling out a tick test request form involves providing accurate information about the tick bite, accompanying symptoms, and personal details. This form is needed by individuals seeking testing for tick-borne diseases, healthcare professionals, and research organizations conducting studies on tick-related illnesses.

For pdfFiller’s FAQs

What is tick test request form?

The tick test request form is a form used to request testing for ticks on animals or in the environment.

Who is required to file tick test request form?

Anyone who suspects they may have been exposed to ticks or tick-borne diseases may be required to file a tick test request form.

How to fill out tick test request form?

You can fill out the tick test request form by providing your personal information, details of possible exposure to ticks, and any relevant medical history.

What is the purpose of tick test request form?

The purpose of the tick test request form is to facilitate the testing of ticks for the presence of diseases and help prevent the spread of tick-borne illnesses.

What information must be reported on tick test request form?

The tick test request form may require information such as your name, contact information, location of possible tick exposure, and symptoms experienced.

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