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Alergy Test Application Form
If you would like to have an alergy test performed simply print out and fill in this form and post it with your remittance for IR£60.00 to the address below.

Initial Questionnaire please fill in your details below

Name
Address
Daytime Phone Number
Email Address
Sex
What complaint do you suffer from?
How long have you suffered from this?
What medication are you on?
Do you drink/smoke?
Age

Note: No obligation. No unsolicited contact.
Information received will be strictly confidential
and will not be used for any purpose other than
contact regarding this query.
No information received
will be forwarded to any third party.

 

 

Herbal Health Co. Ltd.
Farran Business Park, Ardagh, Co. Limerick. Ireland.
Tel: 00 353 69 76005 - Fax: 00 353 69 76042
Email: info@herbalhealthforyou.com