Organ Assessment Test

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Purchase the Allergy and Organ tests for only $289 - Save $29 >>>

Choose your test(s)

Allergy Test

Foods, additives, environmental irritants...

Vitamin/Mineral Test

This test reveals Vitamin or Mineral deficiencies...

Organ Assessment Test

Test the function of all of the major organs...

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Contact information

 Terms & Conditions
* First name:
* Surname:
* Street name & no.:
* Suburb:
* City:
* Postcode:
* Phone: (Country & area code)
* Date of birth: (dd/mm/yyyy)
* Date of hair sample: (dd/mm/yyyy)
* Email
How did you hear about us?
Add me to the NZ agents Quintessence mailing list? Your privacy

Testing Information

Are you currently experiencing any of the following symptoms?

(please read through the list of symptoms below and click the appropriate boxes)

Digestive:
Bloating Stomach Pain / Discomfort Abdominal Pain / Discomfort
Heartburn Flatulence
Belching Diarrhoea Constipation Nausea
Respiratory:
Hay fever Sinus Congestion Asthma Hyperventilation
Chronic Post Nasal Drip Lung congestion Wheezing Cough
Chronic sore throat Ear infections Hoarseness
Skin:
Eczema Dermatitis Hives Psoriasis Itching Rashes
Dry skin Oily skin Flaky skin Hair loss Oily hair Brittle Nails
Urinary:
Kidney stones Chronic bladder infections Bed wetting
Male Reproductive:
Prostate Enlargement Prostate Infection Infertility Low Libido
Female Reproductive:
Fibroids Polycystic Ovarian Disease Endometriosis PMS
Menopause Low Libido Infertility
Endocrine / Hormonal (general):
Weight loss Weight gain Heat Intolerance Cold Intolerance
Shaking and/or Sweating relieved by foods (sugars)
Cravings (food) Cravings (alcohol / nicotine)
Immune:
Chronic Infections Frequent ear infections Slow Wound Healing Allergies
Mental/Emotional/Neurological:
Anxiety Depression Inability to concentrate Insomnia
Irritability Fatigue Tremor
Musculoskeletal:
Joint pain Lower back pain Muscle pain / cramps Neck pain
Headaches (general) Headaches (migraine)

Current Medication

(please ticket the appropriate box/es)

ADHD medication
Antacid medication (over-the-counter or prescribed)
Anti-inflammatory medication
Antidepressant medication
Anti-anxiety medication
Antihistamine medication
Blood pressure medication
Contraceptive pill
Cholesterol-lowering medication
Cortisone (Prednisone)
Hormone replacement therapy (conventional)
Hormone replacement therapy (bio-identical/natural)
Thyroid hormone medication (thyroxin)
Other (please specify):

Current Nutritional Supplementation

What supplements are you currently taking? (Please list)

Allergy Information

Do you have any known allergies?
Yes No
If yes, please list:
Have you been tested for allergies?
Blood tests Skin prick tests
What foods are you currently avoiding?

Please scroll down using the slider to complete the rest of the form.
Thank You

Secure Payment

Currency:
Credit card payment only
Credit Card
Cheque (NZ only)
Direct payment
Urgent order + $30.00
Receive the results in 2 weeks (from when we receive the sample) instead of 3-4 weeks.

Total: $0.00 NZD

After payment, cut a lock of hair and send to us.

Address and instructions will be provided.