Equine Hair Mineral Analysis Submittal Form
4
SPECIAL NEEDS
Joint, Hoof, Calming, Metabolic and Neurotransmitter Support.
3 2 1
ADD
Antioxidants and Phytonutrients for Immune System and Detoxification Support.
BUILD UPON
Vitamins and Minerals to balance forage, feed and work level. Probiotics and Enzymes for Digestive Support.
START WITH
Forage, Low Starch Feed, Essential Fatty Acids.
1. Start with a foundation of forage, feed and high quality essential fatty acids.
2. Build upon this with targeted vitamin
mineral support to balance the forage, feed and work level, along with a digestive enzyme and probiotic blend to support optimal digestion of nutrients.
3. Add Antioxidants and Phytonutrients to
support natural Detoxification and the Immune System.
4. Consider customized supplements
according to your horse’s special needs.
• Joint Tissue Support • Calming • Neurotransmitter Support • Hoof Tissue Support • Blood Sugar Support • And More
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
Owner’s Name: ______________________________________________________________ Address:___________________________________________________________________ City:______________________________________________________________________ State:______________ Zip:_______________ Phone: (_____)___________________________________________ Fax: ______________________________________________________ Email Address:________________________________________________________________ (if email address is provided, we will email results)
SEND RESULTS TO: (if different than above) Address:___________________________________________________________________ City:______________________________________________________________________ State:______________ Zip:_______________
Submitted By:_________________________________________________________________
EQUINE INFORMATION: Select One:
q New Test
q Re-Test, Previous test date:_________________________________
Horse’s Name:______________________________________________________________________________ Breed: ___________________________________________________________________ Age:____________
Hor se Ow : Rock ner y : Sa rah
HOW TO SEND IN A SAMPLE
Nutritional Foundation
q Filly q Open Mare
q Colt q Gelding q Stud q Bred Mare, due date ______________
Height:______________________________ Weight:____________________________ Current Medications: _______________________________________________________________________________________________
_______________________________________________________________________________________________
Health Concerns or Chronic Problems:________________________________________________________________________
• The sample should be taken in small portions from several areas of the horse’s mane. • Cut the hair as close to the neck as possible. • Length of hair should not exceed 2 inches. • 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 horse’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:____________________________ Signature:______________________________________________________________________
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.
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.