Test Submission Form

Fill out the Test Submission Form

Please complete this Test Submission Form. Fill out one(1) Test Submission Form per individual tested. Provide a valid email address to receive results. Note that results are only available via email. We do not mail results.

Once you complete this Test Submission Form, print the form out and follow the instructions on how to collect your hair sample. Send in your hair samples along with your completed form to the address provided.

Company reserves the right to perform the test by any technology and methodology it deems appropriate.

Please select the test you ordered
Personal Details
Dietary/Allergy History *

Your dietary history and known or suspected food sensitivities and allergies

Your known or suspected environmental sensitivities and allergies

* Required fields