Swimmer's Itch Reporting Form Name * Name First First Last Last Email * Todays Date * Do you have any of the following symptoms? (Check all that apply) * Tingling or itching of the skin Small reddish pimples Small Blisters No Symptoms Please provide a description of the lake location where you think you may have gotten Swimmer's Itch * Date of your latest swimming activity * Approximate time of your latest swimming activity * Wind Direction * Onshore (Waves moving towards the shoreline) Offshore (waves moving away from the shoreline) Along Shore (Waves are moving lateral to the shoreline) No Wind Don't Know What apparel were you wearing? * Approximately how deep was the water you were swimming in? * 0-2 ft 3-5 ft 6-10 ft 10+ ft Have you gotten Swimmer's Itch before this incident? * Yes No If you have gotten Swimmer's Itch before, please describe * How old are you? * Are you a part of a rashguard study? * Yes No No, but I would like more information Brand and Size of Rash Guard worn during the time in the water How long were you actively in the water? (minutes) If you are human, leave this field blank. Submit