This is for the kit to submit your sample.

This does not include the visit with Dr. Byron to review the results.

Please note:

Once you receive your forms, complete the highlighted fields on both the sample envelope and requisition form. Print clearly to prevent errors and delays.
Review the instruction card provided by the lab. The sample should include approximately one full teaspoon of hair.
Samples should not be collected from any portion of hair that is permed, colored or chemically treated. If scalp hair is not suitable, please collect sample from other areas such as pubic or axillary.
Please contact our office at 262.672.6393 immediately after mailing your sample to the lab to schedule your appointment. Hair Tissue Mineral Analysis appointments should be scheduled 3 to 4 weeks in advance.

Hair Tissue Mineral Analysis Kit (Please indicate user of kit)