Allergy & intolerance Test Form

HAIR TEST COSTS $99.00

IF YOU WOULD LIKE TO TEST FOR FOOD ALLERGIES AND INTOLERANCES SIMPLY FOLLOW THE INSTRUCTIONS

STEP 1 : Cut a lock of hair (from the roots) of approx 1 inch in length and .5 inch in width. Colour treated hair is fine. Please wrap hair sample up in a small piece of paper or in a zip lock bag clearly marked with your name, address and phone number. 

STEP 2: Fill in the Allergy/intolerance testing health form below.

STEP 3: Email this form back to us by clicking the submit button, at the bottom of the page, and send us your hair sample and payment of $99.00, or print this form and send to us with your hair sample and payment of $99.00 (cheques made payable to elementa). EAV hair testing will be processed once payment has been received. 

We will only contact you once we have the results unless otherwise requested.

Send your cheque and hair sample to:

Elementa
347 Remuera Road
Remuera
Auckland
New Zealand

 

Allery/Intolerance Testing

EAV HAIR TEST
Bloating
Belching
Pain
Diarrhoea
Flatulence
Constipation
Hay fever
Chronic catarrh
Sinus congestion
Bronchial congestion
Asthma
Wheezing
Hyperventilation
Eczema
Itching
Acne
Dermatitis
Rashes
Hives
Dry flakey
Bed-wetting
Chronic bladder infection
Chronic infections
Frequent ear infections
Anxiety
Depression
Inability to concentrate
Insomnia
Irritability
Joint pain
Lower back pain
Fatigue
Dark circles under eyes
Inability to lose weight
Headaches
Hypoglycaemia
Itchy nose or throat
Migraines
Hyperactivity
Yes
No