Application form - Hair Tissue Mineral Analysis (HTMA)

Congratulations! 

Please complete the Tissue Mineral Analysis (HTMA) application form below,
collect your hair sample and mail to:

Heart2heart Nutrition
PO Box 751 Cremorne Junction NSW 2090

You are well on your way to making a real difference in your life.

Application form - Hair Tissue Mineral Analysis (HTMA)

Sex

Are you pregnant?

Have you had a HTMA previously?

Please List your symptoms

Note:

Samples should not be obtained from hair that is permed, coloured or chemically treated.  Untreated hair provides the most reliable results.
Hair treatments and preparation may artificially elevate the result of some elements reported.

Thank you for filling out this form.

Your Hair Analysis will be processed once we have received payment and your mailed hair sample plus the application form.  

Bank Details:
Account Name: Heart2Heart Nutrition
BSB: 112-879 Account: 469968684

When your report is returned to the clinic within 14-21 days we will make contact to organise your Initial Consultation.