Hair Analysis Kit Request Form

"*" indicates required fields

You will only be invoiced for kits used once the sample(s) arrives at the laboratory. Results will be sent by email upon receipt of payment.

How many kits would you like?*

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

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Comments

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If you have any questions, please contact:

Julie Christensen
julie.christensen@trichanalytics.com
Phone: +33 6 59 94 61 95