HairSense Nutrition - Food Compatibility Analysis

HairSense Nutrition - Food Compatibility Analysis

HairSense Nutrition is a personalised food compatibility analysis that compares your hair sample with over 600 foods and household items using bioenergetic principles.The purpose of this form is to collect the information required for Real Functional Health to submit your sample to the laboratory on your behalf and ensure your results are accurately prepared and interpreted
Please complete the following form as accurately as possible to support your HairSense Nutrition analysis.

🔒 Privacy notice

The personal information collected in this form is used solely to support your HairSense Nutrition analysis and is handled in accordance with our Privacy Policy. View our Privacy Policy Here
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail*
example@example.com
Please tick any symptoms that are currently relevant to you. This helps provide additional context when reviewing your results.*

AcneADHDArthritisBad BreathBloatingBrain FogConstipationDiarrheaDigestiveEczemaExcess mucusFatigueFlatulenceHeadachesHormonesIrritable BowelImmune-lowMigrainesPsoriasisRashes/Itchy skinRestless legsSinus/Hay feverSleep IssuesThrushOther
Photo of your labelled hair sample (required). Please upload a clear photo of your hair sample placed in a small glad bag and clearly labelled with your full name, and your practitioner’s name: "Chantel Ryan – Real Functional Health". This ensures your physical hair sample can be accurately matched to your analysis form when we submit your details to the laboratory on your behalf.*

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This photo is used for identification purposes only and is not shared outside of Real Functional Health and the testing laboratory.
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