Mediscan

Step 1: Patient Details

Step 2: Sample Collection

Step 3: Authorization

Step 4: Supplement Option

Step 1 - Details of Patient

Family Name

Other Names

Date of Birth

Address

City/State

Country

Hair

My hair is dyed

My hair is not dyed

Practitioner

I do not have a Practitioner

Recommended by my Practitioner

Practitioner’s Name

Price of test and report: $169 AUD (inc GST)

Step 2 - How to collect and post a hair sample

Please post us a sample of your hair:

Use a paper or a plastic envelope to collect your hair sample and another envelope in which to post us the sample.
Preferably cut hair from your nape area use scalp hair only.
Send us about two heaped tablespoons i.e. about 500mg.
Print off this receipt or your PayPal invoice and include it in the envelope or, write the Order Number on this invoice, or your PayPal Receipt Number, on the envelope containing your hair sample.
Post the sample to: Mediscan, 322-324 Canning Highway, BICTON WA 6157, AUSTRALIA. We recommend using registered or certified mail.
Your report will be emailed to you within ten days of us receiving the sample.

Cut hair from your nape or collect from several scalp areas
Keep the first 5cm nearest to the scalp – discard the rest
Send us about two heaped tablespoonfuls or about 500mg

Step 3

Authorization

I authorize Mediscan (directly and through its contractors) to analyze my sample(s) as submitted to Mediscan and to forward the results of the analysis to the email address stated above and I authorize Mediscan to disclose my personal information (including the test result) to Mediscan’s medical consultants and contractors (subject to them agreeing to be bound by the Australian National Privacy Principles). I accept that Mediscan will not be able to process my Hair Test and email my results unless:

I provide a valid email, and
I insert the Order Number into the envelope.

Date

Step 4

Choose your Supplement Option

Solgar

Compounded Prescription

Sanctuary Wellness Generic

Sanctuary Wellness CPD

Churchill Health Centre Patient

Bioceuticals

Bioceuticals "A"

Generic

All Types

Report Samples