Report a Case of Swimmer's Itch

Information posted here will help us in the research
to reduce or eliminate this aggravating disease.
Reporter's Information
*First & Last Name
*Email Address
*How certain are you that the infected
individual has swimmer's itch:
Infected Individual's Information
*Gender of infected individual:
*Age of infected individual:
*Date individual contracted swimmer's itch
*Time of day when individual was in water:
*Total minutes spent in shallow (i.e., <2 feet) water:
*Number of papules (i.e., "itchy spots")
Site Information
*Name of body of water:
*required field
Questions or Comments