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Hair mineral testing

Health questionnaire

A small section of hair being lifted and cut close to the scalp with scissors

The laboratory needs this before testing can begin. It only takes a few minutes to complete and gives your naturopath the background they need to interpret your results in the context of your health, history and symptoms.

Before you start. Only your name, your email and your date of birth are needed, and a blank answer is still an answer everywhere else. Nothing here is checked by a machine — a person reads it, so write it the way you would say it.

We ask for the date rather than the number so your age is still right when your sample reaches the laboratory. It fills the age box in for you.

Worked out from your date of birth, so there is nothing to type here.

From your receipt, if you have already paid.

Health history

Select the 5 that best describe you.
You may tick more if other options genuinely apply.

General health30
Muscles, bones and joints16
Heart and circulation11
Digestion and liver13
Kidneys and bladder6
Nerves and brain9
Mood, behaviour and memory9
Hormones and thyroid6
Male reproductive health4
Menstrual and reproductive health12

Use this space to tell us anything else about your health or circumstances that you think may be relevant to your test.

Names and doses.

Names and doses.

Tell us about your usual diet and the water you drink. Include any major dietary restrictions and whether you mainly drink tap, filtered, bottled or tank water.

Work, hobbies, renovations, old paint, soil, water.

About the sample

Anti-dandruff and mineral-based shampoos matter here.

Goes to the clinic, not to the laboratory. Nothing is stored on this website.

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