Wildlife Disease Monitoring Survey
Report observations of wildlife disease to support monitoring and research efforts.
Observer's Full Name
*
First Name
Last Name
Observer's Email Address
*
example@example.com
Date and Time of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Observation (Address or GPS coordinates)
*
Species Observed
*
Please Select
Bird
Mammal
Reptile
Amphibian
Fish
Other (please specify)
Symptoms or Signs Observed (Select all that apply)
*
Lethargy or unusual behavior
Visible wounds or lesions
Respiratory distress
Unusual deaths
Emaciation or poor body condition
Other (please specify)
Number of Animals Affected (if known)
Upload Photos or Supporting Files (optional)
Upload a File
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Additional Comments or Notes
Submit Observation
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