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HeadLice.Org Hot Spots
 

Reporting Registry

The Registry and its reports are needed to identify problems as early as possible. The NPA can then submit its findings and seek appropriate assistance from experts and governmental agencies including the Food and Drug Administration (FDA).

NOTE: The NPA will not release your personal data. We do not sell or share personal information.
See our privacy policy for more details.
 
Name:
Organization:
(leave blank if none)
Category:
Address:
Address:
(continued)
City:
State:
(US Only)
Zip Code:
Phone:
E-Mail Address:
How Did You Find Us:
 
Date of Outbreak:
please enter in MMDDYY format
example:  062598
Patient Age:

Patient Sex:

 Male
Female
Where did the outbreak occur?
Describe the type of outbreak (lice or scabies)
and provide any additional notes:
Does your community/organization have a head lice prevention program? Yes No N/A
Have you used a lice or scabies treatment that failed? Yes No N/A
Has a lice or scabies treatment caused you harm or made you ill? Yes No N/A
 
Comments:


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