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Tick Identification WA State ID Number: Instructions Complete This Section 1. Keep the tick alive, if possible. 2. Place 1-2 blades of grass with the tick into a small plastic or metal container (an empty pill bottle works well). Close 3. Put the container holding the tick into a sealed plastic bag. Place the bag into a padded envelop for mailing. 4. Complete this form and mail it with your tick to: WA Tick Identification Zoonotic Disease Program PO Box 47825 Olympia, WA 98504-7825 Note: The submitter must pay the shipping cost. You will be notified of your tick species result by email. Remove a Tick and Properly Date the tick was Description of where the tick was most likely acquired such as address, town, wilderness area, or GPS coordinates. Include county and zip code. County Zip Code Activity when tick was acquired: Hiking Dog Walking Gardening Other Tick was found on: Human Dog Cat Other Was the tick attached? Yes No If tick was found on a person, what was their age and gender? Age Gender Travel outside Washington in past two weeks? No Yes, where? Tick submitted by: Email Phone You will be notified by email on the identification results. For More Information Tick identification is available through the Washington State Department of Health’s Zoonotic Disease Program. Identifying the tick species may help a health care provider diagnose an illness that could be associated with a tick bite. If a fever, rash, or flu-like illness occurs within a month of the tick bite, contact your health care provider and let them know you were bitten by a tick and that you had the tick identified. For more information on tick bite prevention and tick-borne disease, see http://www.doh.wa.gov/ticks. For questions about this form, contact us at 1-[PHONE REDACTED] or [EMAIL REDACTED]. Washington State Department of Health Use Only Tick Local ID Date Received: Date Entered: Identified as: on ♂ ♀ Larva Notification Date: Testable: Yes No Grasp the tick close to the skin with tweezers. Gently pull straight up to remove the tick. Disinfect the bite site. DOH 333-179 September 2014 For people with disabilities, this document is available on request in other formats. To submit a request, please call 1-[PHONE REDACTED] (TDD/TTY call 711).