Transcription of TICK IDENTIFICATION AND TESTING FORM - …
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TICK IDENTIFICATION AND TESTING FORM - …
Form revised March 2020 Michigan Department of Health and Human Services Bureau of Infectious disease Prevention Emerging zoonotic Infectious disease Section PO Box 30195 333 S. Grand Avenue, 3rd Floor Lansing, MI 48909-7695 TICK IDENTIFICATION FORM Print or type information below and mail this form with the tick in a sealed container to the above address. Submitter Information: Name: _____ Address: _____ City: _____ State: _____Zip: _____ Phone Number: _____ Send RESULTS to (select only one option): Mail to address above Email: _____ Alternative address: _____ _____ _____ _____ Tick Information: Date tick was collected: _____ Please indicate (check) if tick was found on a: Person Animal Other If animal or other, please speci
Michigan Department of Health and Human Services Bureau of Epidemiology and Population Health Emerging & Zoonotic Infectious Diseases Section PO Box 30195
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