Dutchess County Legislature
Tick Task Force Informational Survey

* Questions denoted with an asterik must be answered.

* How long have you resided in Dutchess County?
      0-4 years
      5-10 years
      11-20 years
      More than 20 years

* Do you have a tick removal kit at home?
      Yes
      No

* Have you or a family member been diagnosed by a health care professional with a tick-borne disease?
      Yes
      No

* Have you experienced challenges with diagnosis or treatment of your tick borne disease?
      Yes
      No

If yes, please describe:
    

* In what part of Dutchess County do you reside?
     - Select Municipality - Amenia Beacon Beekman Clinton Dover East Fishkill Fishkill/Town Fishkill/Village Hyde Park LaGrange Milan Millbrook Millerton North East Pawling/Town Pawling/Village Pleasant Valley Pine Plains Poughkeepsie/City Poughkeepsie/Town Red Hook/Town Red Hook/Village Rhinebeck/Town Rhinebeck/Village Stanford Tivoli Union Vale Wappinger Wappingers Falls Washington

If you would like to join a Lyme Awareness email list, please enter your email address:
    

*** Enter the following number in the box below before submitting your Survey:      ***