Food and Chemical Sensitivity Testing Form

Test Form

The cost of the test is $170 +$5.00 per additional item to be tested. A one hour appointment is required to go over the result which costs $120.00.

Please fill in the details below and a downloadable form will be sent to you which must be included with your hair sample. The instructions for taking the sample will be on the downloadable form, as well as being at the bottom of this page. Please follow the instructions carefully to ensure we get a usable sample. Any questions, please call 028 416 2654

The Self Heal Clinic Ltd, 14 South Belt, Solway, Masterton 5810, New Zealand.
Your Name*
First Last
Address*
Street Address Address Line 2 State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Age*
Gender*
Please advise whether you have been referred by a practitioner and if so, who?*
A brief outline of your symptoms:*
Medications/supplements you are currently using:*
Do you have any known allergies?*
Are you avoiding any foods?*
Name
This field is for validation purposes and should be left unchanged.

How to Take the Sample

The approximate size of the hair sample required is a 5 mm thick bunch of hair. It must be cut at the ROOT, close to the skin.

You can use any body hair if the head is shaven. Eg: leg, pubic, chest or underarm. The presence of hair dye is not a problem if it is older than 2 weeks.

Hair samples should be contained in a small sealed plastic bag.

Any additional items to be tested must be appropriately packaged and labelled or they will not be included.

Tests take approximately 4 weeks to process.

When we receive your sample, we will contact you to arrange payment. All tests must be paid for prior to the test being carried out.

Thank you for using our service and we look forward to helping you in your health journey.