Please read and action the following procedure:

1) Complete the questionnaire below and click on "send"

2) When the Acknowledgement and Payments page appears, make payment by clicking on the Paypal icon. You do NOT need a PayPal account, just a credit or debit card. We do not have access to your details.

3) Upon receipt of your questionnaire and payment you will receive an auto response. We pride ourselves on personal service; you will receive an emailed acknowledgement from Hebe within 24 hours of your payment arriving together with full instructions on how to proceed

4) If you prefer to submit your details by post or pay by cheque, please contact us for instructions on how to proceed by clicking here

The cost of your Hair Analysis Test is £47.00

Testing Your Child
If you would like to have your child's hair tested contact us for further details (please DO NOT complete the following information and payment)

QUESTIONNAIRE

Please complete Questionnaire in FULL

Name:


Male/Female:


Address:


Home Tel. No.:


E-Mail Address:


Date of Birth:


Weight:


Height:


What medications are you taking and what are they for (if none please state "none")?


Have you taken any steroids in the last year and if so what for?


Have you taken a course of antibiotics in the last year and if so what for?


Please detail all serious injuries, illnesses and infections, specifying what and when (if none please state "none"):


How many mercury or other metal fillings do you have?


How many cigarettes do you smoke per day?


How many units of alcohol do you drink per week?
(For guidance only: 1/2 pint of average strength beer = 1 unit,
125 ml. glass of 12% wine = 1.5 units)


How many times each day do you consume sugar?
(Count once for each teaspoon of sugar, each biscuit or cake, each small bar of chocolate, etc.)


How many portions of processed food do you eat in a week?
(Include any product from a packet/tin/sachet - count once for each portion consumed)


How many cups of tea/coffee or other caffeine drinks (eg. Cola) do you consume per day?


How many glasses of water, fruit/herb teas and pure unsweetened fruit juice do you drink per day?


Do you consider yourself to be overweight and if so how much?


Please state frequency of bowel movements per week (state a number):


Please assess your personal stress level on a scale of 0 - 10
(0 being NO stress and 10 being HIGHLY stressed):


How many times per week do you exercise for 20 minutes or more?


What form does this exercise take?


Do you take any supplements (vitamins / herbs etc) and if so what?


Please may we ask you how you found our web site (eg. recommendation, search engine, etc.)?


If you used a search engine - what phrase did you use?

Terms and Conditions

It is your right to cancel this contract within 7 days of receiving the second acknowledgement. Owing to the personalised nature of the report there is no right to cancel after this period. Your report will be emailed to you 7 days after our second acknowledgement (please note that when payment is made by eCheque submission of the report may take longer owing to Paypal clearance procedures).

Privacy

Information provided is used solely for the purpose of producing and remitting your report; no information is passed to or shared with any third party. Our secure payment service is conducted through Paypal and we do not have access to your credit card details.