Sample ID*

Included in your Prescription Kit

Site Name

Name of site from which sample was taken

Client Name/Business Name*

Email*

Phone Number*

Total Yardage or Square Footage

1 yard = 200 gallons or 27 cubic feet

Type of soil*

List type(s) of soil being submitted (ex: peat base, coco base, native, etc)

Cultivation type*

Feeding Practices*

Select all that apply.

Any issues last run?

Additional Notes

Name

This field is for validation purposes and should be left unchanged.

Amendment Prescription Kit Submission

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