Test Kits Request Form
Patient details
Title
First name
Last name(s)
Date of birth
Sex
Please Choose…
Male
Female
Patient contact details
Address
Town/City
Postal code
Country
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei Darussalam
Bulgaria
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Chile
China
Colombia
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Barthlemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
South Africa
South Korea
Spain
Sri Lanka
Suriname
Swaziland
Sweden
Switzerland
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Email
Telephone
Referring Clinician’s details
Clinician’s name
Clinician’s phone number
Clinician’s email address
Clinician’s address
Tests kit(s) Required
Please select test kits below:
Choose a test
ADHD (and similar) Profile
ADHD (and similar) Profile – additional tests
Adrenal Profile – urine
Adrenal Profile & Metabolites (DUTCH – dried urine samples)
Adrenal Stress Profile – salivary (Cortisol) and DHEA
Albumin – serum
Alcohol Excess Profile
Alkaline Phosphatase Bone – serum
Allergy Panel – 30 Inhalants (IgE) – serum
Allergy Panel – 20 Foods (IgE) – serum
Allergy Panels – (50 in total – IgE) Food and Inhalants – serum
Aluminium – plasma
Aluminium – urine
Aluminium – blood
Amino Acid Profile – urine
Anorexia Nervosa Profile
Anti-DNAse B
Antimony – urine
Antimony – blood
Antioxidant Activity (total & nutritional) – serum
Antioxidant Profile (serum & blood)
Antistreptolysis Antibodies (ASO)
Arsenic – urine
Arsenic – blood
Arthroplasty Blood Toxic Metal Profile
Auto Antibody Screen
Bariatric Surgery (post) – annual screening
Barium – urine
Barium – blood
Beryllium – urine
Beryllium – blood
Beta-Cryptoxanthin – serum
Bile Acids (total) – serum
Biochemistry Profile
Biotin (Vitamin B7) – blood
Borrelia Antibodies (Lyme Disease) IgG & IgM
Breath Hydrogen & Methane (Small Intestinal Bacterial Overgrowth-SIBO)
Breath Hydrogen & Methane for Fructose Intolerance
Breath Hydrogen & Methane for Lactose Intolerance
Burning Mouth/Mouth Ulceration Profile
Burning Mouth/Mouth Ulceration Profile – additional tests
Cadmium – urine
Cadmium – blood
Caeruloplasmin – serum
Calcium – urine
Calcium – serum
Candida antibodies – serum
Cardiac Arrhythmias Profile
Cardiac Arrhythmias Profile – additional tests
Cardiac Failure Profile
Cardiac Failure Profile – additional tests
Carotenes (alpha and beta) – serum
CFS/ME Profile
CFS/ME Profile – additional tests
Chromium – plasma
Chromium – urine
Chromium – blood
Cobalt – urine
Cobalt – blood
Coeliac Profile (gluten sensitivity screen)
Coenzyme Q10 – serum
Copper – plasma
Copper – urine
Copper Response Test – plasma
Coronary Heart Disease Profile
Coronary Heart Disease Profile – additional tests
Cortisol – serum
C-Reactive Protein (CRP) – serum
Creatinine – urine
DHEA Sulphate – serum
Diabetes Profile
Diabetes Profile – additional tests
Diamine Oxidase (DAO) (Histamine intolerance) – serum
D-Lactate – plasma
DMSA provocation – additional urine toxic metals pre- & post-DMSA (Pb, Cd, Al or As)
DMSA provocation test for mercury – urine
DNA Methylation Pathway Profile
DNA Oxidative Damage (8-hydroxy-2′-deoxyguanosine)
DNAse B
Drug/Nutrient Interactions Profile (severe)
Drug/Nutrient Interactions Profile (severe) – additional tests
D-Xylose Absorption – urine
Endomyseal Antibodies
Eye conditions (degenerative) Profile
Eye conditions (degenerative) Profile – additional tests
Fatty Acids Profile – red cell – blood
Ferritin – serum
Fibromyalgia Profile
Fluoride – Tap Water
Fluoride – urine
Folate – red cell – blood
Follicle Stimulating Hormone (FSH)
Food Sensitivity IgG Panel, 94 Foods + Candida – blood spot or serum
Free T3 – serum
Free T4 – serum
Gamma-Glutamyl Tranferase (GGT)
Glucose – plasma
Glucose Tolerance Test (2.5 hours)
Glucose Tolerance Test (5 hours)
Glutathione Peroxidase, red cell & plasma – blood
Glutathione Reductase (RBC/serum) – blood
Glutathione-S-transferase – serum
Glutathione, red cell – blood
Glyphosate
Glyphosate (with Organic Acids or Toxic Chemicals)
Growth and Poor Appetite Profile
Growth and Poor Appetite Profile – additional tests
Growth Hormone – serum
Gut Permeability Profile
Haematology & Biochemistry Profile
Haematology & Biochemistry Profile (postal samples)
Haematology & Biochemistry with Lipids Profile
Haematology Profile (including ESR)
Haemogoblin – blood
Hair Mineral & Toxic Metal Profile
HbA1c – Glycosylated Haemoglobin – blood
Health Risk Profile – blood, plasma & serum
Health Risk Profile (Extended Profile) – blood, plasma & serum
Helicobacter pylori antibodies (IgG) – serum
Helicobacter Stool Antigen
Hepatic Detoxification Profile (D-Glucaric Acid and Mercapturic Acids)
Histamine – plasma
Histamine – urine
Homocysteine – plasma
Hormone Profile – Comprehensive Female I – SALIVA: E2, Pg, T, DS & Cx4 BLOOD SPOT: TSH, fT3, fT4, TPO
Hormone Profile – Comprehensive Female II – SALIVA: Cx4 BLOOD SPOT: E2, Pg, T, SHBG, DS, TSH, fT3, fT4, TPO
Hormone Profile – Comprehensive Male II – SALIVA: Cx4 BLOOD SPOT: E2, T, DS, SHBG, PSA, TSH, fT3, fT4, TPO
Hormone Profile – Comprehensive Male I – SALIVA: E2, T, DS, Cx4 BLOOD SPOT: PSA, TSH, fT3, fT4, TPO
Hormone Profile – Female (blood spot I) – E2, Pg, T, SHBG, DS, C
Hormone Profile – Female (blood spot II) – E2, Pg, T, SHBG, DS, C, TSH, fT3, fT4, TPO
Hormone Profile – Male (blood spot I), E2, T, PSA, SHBG, DS, C
Hormone Profile – Male (blood spot II) – E2, T, PSA, SHBG, DS, C, TSH, fT3, fT4, TPO
Hormone Profile with Thyroid Function Panel – serum
Hormone Trio (saliva or blood spot) – E2, Pg, T
Hormones – Comprehensive Profile (Sex, Adrenals and Melatonin) (DUTCH – dried urine)
Hormones – Comprehensive (includes Sex and Adrenals) – urine
Hormones – Comprehensive Plus (‘Comprehensive’ + Hormone Metabolites & Thyroid) – urine
Hormones – Comprehensive Plus (‘Comprehensive’ + Hormone Metabolites, Thyroid & Human Growth Hormone) – urine
Hormones – Sex Hormones & Metabolites Profile (DUTCH – dried urine)
Hormones – Sex Hormone Profile – urine
IgE Total – serum
Immunoglobulins (IgG, IgA and IgM)
Indicans – urine
Infections (recurrent or severe) Profile
Infections (recurrent or severe) Profile – additional tests
Infertility Profile
Infertility Profile – additional tests
Inflammatory Arthritis Profile
Insulin
Iodine – urine
Iodine:Creatinine Ratio – urine
Iron – serum
Iron & TIBC – serum
Kryptopyrroles (Pyroluria) – urine
Lactose Intolerance – Breath Hydrogen & Methane Test
Lactose intolerance test – blood
LDH (lactate dehydrogenase) – serum
LDL (oxidised) – serum
Lead – urine
Lead – blood
Lipids Profile
Liver Function Tests
Lutein – serum
Luteinising Hormone (LH)
Lycopene – serum
Lyme Disease (Borrelia Antibodies IgG & IgM)
Magnesium – serum
Magnesium – urine
Magnesium (Erythrocytes – RBC)
Magnesium Loading/Retention – urine
Manganese – plasma
Manganese – urine
Manganese – blood
Melatonin Profile – saliva
Menopause (early) Profile
Menopause (early) Profile – additional tests
Menopause Hormone Profile – serum
Mercury – urine
Mercury – blood
Metal Sensitivity (MELISA) – 1 metal
Metal Sensitivity (MELISA) – 5 metals
Metal Sensitivity (MELISA) – Amalgam, Gold & Root Fillings
Metal Sensitivity (MELISA) – Titanium Implant
Methylation Profile
Methylmalonic acid – urine
Methylmalonic acid – serum
Minerals – Plasma Mineral Profile
Minerals – Plasma Mineral Profile + Red Cell Magnesium
Molybdenum – plasma
Molybdenum – urine
Molybdenum – blood
MTHFR (C677T & A1298C) – saliva/blood
MTHFR (common C677T & A1298C) gene mutation – blood
Multiple Sclerosis Profile
Multiple Sclerosis Profile – additional tests
Mycotoxins Profile (MYCOTOX) – urine
Nagalese – blood
Neuropathy Profile
Neuropathy Profile – additional tests
Neurotransmitter Profile – Basic – urine
Neurotransmitter Profile – Comprehensive – urine
Nickel – urine
Nickel – blood
NTX – Type 1c Telopeptides (Bone Loss Indicator) – urine
Obesity Profile
Obesity Profile – additional tests
Oestradiol
Organic Acids – MOAT – Microbial (20 compounds) – urine
Organic Acids – OAT – (73 compounds includes Microbial) – urine
Organic Acids – Addition of Phospholipase A2 (PLA2) to either of Organic Acids Profiles
Osmolality – urine
Osteoporosis Profile
Osteoporosis Urine Mineral Screen – urine elements
Paediatric Poor Growth Profile
Paediatric Poor Growth Profile – additional tests
Paraoxonase – blood
Parathyorid Hormone
Peptides Profile (for Casein and Gluten) – urine
Phospholipase A2 (PLA2) – urine
Phosphorus – serum
Phosphorus – urine
Porphyrin Profile – urine
Porphyrins (Doctor’s Data)
Potassium – plasma
Potassium – urine
Progesterone
Prolactin
Psychosis Profile
Psychosis Profile – additional tests
Reverse T3
Selenium – plasma
Selenium – red cell (blood)
Sex Hormone Binding Globulin
SIBO – Small Intestinal Bacterial Overgrowth Breath Test
Sodium – plasma
Sodium – urine
Steatorrhoea and Malabsorption Profile
Steatorrhoea and Malabsorption Profile – additional tests
Stool – C. Difficile DNA
Stool – Chemistry only
Stool – Clostridium Culture (comprehensive)
Stool – Comprehensive Parasitology (2 samples)
Stool – Comprehensive Parasitology (3 samples)
Stool – Comprehensive Stool Analysis with Parasitology (2 days)
Stool – Comprehensive Stool Analysis with Parasitology (3 days)
Stool – Microbiology
Stool – Secretory IgA
Stool – Yeast Culture & Sensitivity
Streptococcus Antibody Profile (ASO & DNase B Antibodies) – ‘PANDAS’
Sulphites – urine
Superoxide Dismutase (SOD) – red cell (blood)
T3 – Reverse
T3 – Total
T3 Free – serum
T4 – Free
Tartrate Resistant Acid Phosphatase (TRAP) – serum
Testosterone – serum
Thallium – urine
Thallium – blood
Thyroid Antibodies – serum
Thyroid Plus Profile (Thyroid Antibodies, TSH, Free & Total T4, Free T3, Reverse T3)
Thyroid Profile – Essential (blood spot) – TSH, fT3, fT4, TPO
Thyroid Profile (TSH, FT4 & FT3)(LC7E)
Thyroid Profile 1 (TSH, FT4)
Thyroid Profile 2 (TSH, FT4 & Thyroid Antibodies)
Thyroid Stimulating Hormone (TSH) – serum
Tin – urine
Tin – blood
Total Iron Binding Capacity – serum
Toxic Elements Screen – Tap Water (13 metals + fluoride)
Toxic Elements Screen – Tap Water (13 metals)
Toxic Elements Screen (18 elements) – urine
Toxic Elements Screen (16 elements) – blood
Toxic Elements Screen (18 metals) plus Fluoride – urine
Toxic Organic Chemical Exposure Profile (GPL-TOX) – urine
Toxic Organic Chemical Exposure Profile (GPL-TOX) (in addition to either Organic Acids Profiles) – urine
Trimethylaminuria (TMAU) – urine
Urinalysis with Multistix
Urinalysis, Microscopy, Culture and Sensitivity
Viral Antibody Screen
Viral Disease Profile (Human Herpes Virus, HHV6, EBVA (IgG/IgM), CMV, IgG, CMV, IgM)
Vitamin A (Retinol) – serum
Vitamin B Profile (B1, B2 & B6)
Vitamin B1 (Thiamine), Transketolase Activation – blood
Vitamin B12 & Folate Profile
Vitamin B12 (‘active’) and Methylmalonic Acid Profile – serum
Vitamin B12 (‘Active’ ) (Holotranscobalamin) – serum
Vitamin B12 (‘Active’) and RBC Folate Profile
Vitamin B2 (Riboflavin), glutathione reductase activation – blood
Vitamin B3-RBC NAD Activation (Niacin) – blood
Vitamin B5 (Pantothenic acid)
Vitamin B6 (Pyridoxine), Glutamic Oxaloacetic Transaminase Activation – blood
Vitamin C (Ascorbic Acid) – serum
Vitamin D (25-hydroxy) Profile – serum or finger-prick blood-spot sample
Vitamin E (Alpha & Gamma Tocopherol) – serum
Vitamin E (Tocopherols) in Erythrocytes – blood
Vitamin E Profile (Alpha, Delta & Gamma Tocopherols) – serum
Vitamin K and PIVKA-II Profile – serum
Vitamin Profile – Comprehensive (A,C,D, E, Carotenes & B1, B2 & B6, ‘active’ B12, RBC Folate)
Vitamin Profile (A,C,E, Carotenes & B1, B2 & B6)
Vitamins – Fat Soluble Vitamin Profile (A, Carotenes, & E)
Weight Loss Hormone Profile – (E2, Pg, T, DS, Cx4, TSH, D2, D3, In, HbA1c)
Weight Loss Hormone Profile with Thyroid – (E2, Pg, T, DS, Cx4, TSH, D2, D3, In, HbA1c, fT3, fT4, TPO)
Zinc – urine
Zinc – plasma
Zinc Challenge Test (1.5 hours) – plasma
Zinc Challenge Test (3 Hours) – plasma
Remove
Add another test
Payment
Who will be paying?
Please Choose…
Send invoice to Patient
Send invoice to Clinician
Request Test Kit
Back to Previous Page
4:02 am UTC
Sunday Oct 21, 2018 (London)
Home
About Biolab
Welcome to Biolab
Latest News
Latest Features
Frequently Asked Questions
Documents for Downloading
Join Our Mailing List
Web and Article Links
Clinicians
Clinicians Overview
Quality Assurance
Referring Patients to Biolab
Clinician Registration Form
What is Nutritional and Environmental Medicine?
Information for Biochemists
Blood Tubes and Test Kits
Publications List
Introductory Reading List
Journal Links
Web and Article Links
Join Our Mailing List
Patients
Patients Overview
General Information
What is Nutritional and Environmental Medicine?
What does Biolab Test for?
Doctors & Nutritionists Available for Consultation
Medical Referral List
Test Samples that can be Posted
Sample Collection Procedures
Patient Instructions Prior to Tests
Blood Tubes and Test Kits
What happens to my results?
Medical Referral List
Quality Assurance
Payment of Fees
Give Us Your Feedback
Tests
A-Z Listing of Biolab Tests
Tests by Medical Condition
Tests by Medical Category
Tests that can be Posted to Biolab
Patient Instructions Prior to Tests
Blood Tubes and Test Kits
Tests Referred to Other Laboratories
Test Forms
Test Request Forms
Test Kit Request Form
Appointments
How to Find Us
Publications/Media
Media and Education
Resources
Publications List
Abstracts
Workshop Recordings
Contact Us
Subscribe
Resources
