TEST SUBMISSION FORMS

                                         

MODERN ALLERGY MANAGEMENT TEST SUBMISSION FORM INSTRUCTIONS:

              YOUR INTOLERANCE TEST – PLEASE READ CAREFULLY:

We only require 4-5 strands of hair , if hair is longer than an inch - We test any body hair, the hair root is preferred but not necessary.  If cutting the hair, please cut as close to the root as possible - Hair dye/color will not affect testing. Once hair sample collected,  place strands into a small sealable bag ensuring the hair remains dry and secure.

 Your Test Form will be sent as a download upon completion of your order. If your have any problems with the download and /or printing the form then you may copy the below information onto a piece of paper.  Or please contact us and we will mail you the Test submission forms

 

                       INCLUDE TEST FORM WITH HAIR SAMPLE

                            MODERN ALLERGY MANAGEMENT

PLEASE COMPLETE THE FOLLOWING DETAILS (YOU MAY COPY THIS INFORMATION ON A PIECE OF PAPER):

PERSONAL DETAILS: Please enter the details of the person being tested:

Title: ____ First name: ___________________

Last name______________________            M______  F________

Date of Birth: ____________________ Postcode / Zip Code:______

TEST ORDERED:----------------------------Order #------------------------------------------ Please provide an email address to receive test results: EMAIL:_____________________________________________________________________                                          ABOUT YOUR ORDER

Name of Purchaser: _______________________________

Date of Purchase:______________ _______________________________ IMPORTANT: Make sure you include this form with submission of your test. One form per person testing. Please make sure that all of the above information is completed.

                     MODERN ALLERGY MANAGEMENT LLC

                                      P. O.  Box 13603

                                  Pensacola, Florida  32591                            INFO@MODERNALLERGYMANAGEMENT.COM         

850-999-7880