Request edit access
Potential Bed Bug, Lice, or Flea Incident
Sign in to Google to save your progress. Learn more
Email *
You are reporting a case of: *
Has your case been confirmed by a Medical Professional? *
If so, when was it confirmed? *
Have you had contact with others? *
Please list ALL of the places you have been on Campus since suspected infestation. Please be as detailed as possible, including times and locations. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Macalester College. Report Abuse