HAIR ANALYSIS FORM

Professional Analysis and Treatments for Hair Loss, Scalp Disorders and Skin problems.

Please submit online. If you prefer, you can printout, email, fax or post this form to us.

Hair Sample Instructions

Pluck a sample of hair from the scalp (using fingers or tweezers), from an area of scalp near the problem area. This is important as a sample from a different area of the scalp may give a misleading result. We need at lease 10-20 hair bulbs for an accurate analysis. These should be growing hair NOT hair that has already fallen. The hair sample can then be wrapped in paper and placed in an envelope together with the hair analysis form and analysis fee of £25.00 and send to the address below. Alternatively, the analysis form can be completed on-line, e-mailed and fee paid by credit card. Fee can also be paid in the product page. If you require any further information about this process please e-mail or telephone us at 01475 724629. A full analytical report will be e-mailed or sent to you detailing recommended treatments.

Should you decide to proceed with the treatments you may order via e-mail, online, or by post, including your cheque.

Instructions: Complete form below or print off paper version to post via mail.

Please answer as many of the above questions as possible. If unsure please leave blank or contact us for information.

  

Ninian Smith, 46 Inverkip Street, Greenock, PA15 1YT, Scotland, UK: Fax: 01475 729 255
E-mail: info@niniansmith.co.uk
You may book a personal appointment for consultation and analysis.

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