Thank you for sharing your beach-related illness with us. Please describe your illness and location in the title and other fields. (Para español favor de cambiar el idioma arriba y elegir la forma correcta a continuación.")

To learn more about your local water quality, visit go.surfrider.org/beachwaterquality. Please also consider reporting your sickness to your local health department and/or beach testing agency.

Submit a New Report

Select A Form Type

Report Title *

Description *

Allowed HTML tags: "a, p, img, br, b, u, strong, em, i".
Iframes are only allowed from: www.youtube.com/embed/, player.vimeo.com/video/, w.soundcloud.com/player.

Modify Date Date & Time: Today at 06:12 am (America/Los_Angeles)

Date

Time

:: (America/Los_Angeles)

Categories *

What were your symptoms? Check all that apply: *

Did you see a doctor? *

If treated, what was the diagnosis and treatment?

How long after you were in the water did your illness symptoms start? *

How many times have you been sick from the water at this beach?

How long did your illness last? *

Will you allow Surfrider Foundation to contact you? If yes, please provide info below. This will not be shared publicly. *

Did you observe a distinct source of pollution or algal bloom? Please describe. *

Which state (if US) or country (if non-US) were you visiting? *

Optional Information

First Name

Last Name

Email

Find a location near you

* Search for your location using a location name OR latitude,longitude coordinates (format: 38.19, 85.61), OR click on the map to pinpoint the correct location..

Location Name *
Example: Corner of City Market, 5th Street & 4th Avenue, Johannesburg

News Source Link

add

External Video Link

add

Upload Photos

add