Hair Mineral Analysis Canine Form

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It also tests for the content of toxic minerals, including: • Antimony • Uranium • Arsenic • Beryllium • Mercury • Cadmium • Lead • Aluminum

Blood tests are just a snapshot in time and can miss issues at the cellular level. Hair mineral analysis shows a synopsis of mineral levels over several months’ time.

Address:___________________________________________________________________

photo of cutting from neck of dog

HMA can identify: • Mineral deficiencies, excesses and imbalances • Metabolic balance • Sugar handling capabilities • Stress response and recovery • Endocrine and digestive patterns • Toxic metal presence • Inflammatory patterns

Phone: (_____)___________________________________________ Fax: ______________________________________________________

(if email address is provided, we will email results)

SEND RESULTS TO: (if different than above) Address:___________________________________________________________________ City:______________________________________________________________________ State:______________ Zip:_______________

Submitted By:_________________________________________________________________

CANINE INFORMATION: Select One:

q New Test

q Re-Test, Previous test date:_________________________________

Dogs’s Name:_______________________________________________________________________________ Breed: ___________________________________________________________________ Age:____________

The hair mineral analysis also analyzes these key nutrient ratios: • Calcium/Phosphorus • Sodium/Potassium • Calcium/Potassium • Zinc/Copper • Sodium/Magnesium • Calcium/Magnesium • Iron/Copper • Calcium/Copper

City:______________________________________________________________________ State:______________ Zip:_______________

Email Address:________________________________________________________________

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The hair and mineral analysis tests for the content of the following fundamental minerals: • Calcium • Magnesium • Sodium • Potassium • Copper • Zinc • Selenium • Iron • Chromium • Boron • Manganese • Cobalt • Molybdenum

Owner’s Name: ______________________________________________________________

Dog : Ow Piper ner : Sa ra

What minerals do we test for?

HOW TO SEND IN A SAMPLE

Canine Hair Mineral Analysis Submittal Form

q Spayed q Intact q Neutered q Intact Female Female Male Male Weight:_____________________ Current Medications:________________________________________________________________________________________________ __________________________________________________________________________________________________________________

Health Concerns or Chronic Problems:_________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

• Sample should be cut from the neck area, where a collar would naturally sit, closest to the dog’s skin. • Amount of hair needed for an accurate analysis is approximately one tablespoon. • Hair should not be sampled from other parts of the body, as it may not reflect an accurate representation of mineral balances. • Put the hair sample in plastic pouch labeled with the dog’s name and your name. • Place form and plastic pouch in postage paid envelope and mail back to Uckele.

Payment ($249.95 per test / 3+ $229.95 ea.): q Web Order Prepaid q Check or M.O. Enclosed

q Credit Card (Visa, MC, AmEx, Discover accepted)

Credit Card #:___________________________________________________________________ Exp. Date:______________________________ CVV Code:____________________________

Place form and plastic pouch in postage paid envelope and mail back to Uckele. Allow up to 4 weeks for the results that will include a graph, recommendation/summary page, and a phone consultation with a nutritionist explaining the results.

Signature:______________________________________________________________________ Hair Mineral Analysis (HMA) information is for self-educational and informational purposes only and in no way is intended as medical counseling or medical advice concerning any medical condition, disorder or disease. None of the services, information, statements or products discussed have been evaluated by the FDA and are not intended to diagnose, treat, cure or prevent any disease. Always seek professional medical advice from your physician or other qualified health care provider with any questions you may have regarding a medical condition.


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