Renew U DNA 360 Interest Form

DNA 360 Interest Form

Note: Submitting this form does not place an order. This is Step 1 to connect you with our BSN-trained Registered Nurse & Functional Genomic Certified Practitioner. We’ll reach out with next steps: either order the DNA 360 test alone or choose our recommended package—DNA 360 test kit + consultation—where you’ll receive a personalized instruction manual you can reference for life. Adding your address lets us prepare shipping if you decide to order.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
I’m curious and just want more information for now.Please notify me when testing becomes available—I’m very interested.I’m ready! I know I’ll be scheduling as soon as testing opens.
I’m struggling and looking for answersI feel okay but know I could feel betterI’m mostly healthy but want to optimize and prevent issuesI’m doing this for my kids or familyI’m proactive and love learning more about my body
Improving energy or reducing fatigueBalancing hormonesUnderstanding my mental/emotional health (anxiety, mood, sleep, etc.)Weight management or metabolismChronic symptoms without clear answersPreventative/longevity-based healthParenting support or understanding my child’s healthAthletic performance or recoveryDetox and inflammationJust curious and want to optimize my wellnessOther
What would success look like for you with this testing and consultation? What’s the change or clarity you’re most hoping for as a result of learning your genetic blueprint?
Test Kit Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
"Please note, many carriers do not successfully ship orders to PO Box. It is preferred to use a full shipping address. If you do continue with a PO Box your order may be delayed or not arrive, and another order will need to be placed"
Should be Empty: