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Brunswick Health

Step 3 of 4

Your health questionnaire

This takes about ten minutes, and payment comes straight after it. The laboratory reads your result against your history rather than against an average, so the answers here are what turn a column of numbers into something a practitioner can actually use.

Where this sits

  1. Prepare your hair sample.
  2. Send it to Brunswick Health Hair Mineral Testing, 1/68 Melville Road, Brunswick West VIC 3055 — or drop it at reception.
  3. Complete this questionnaire. You are here.
  4. Finalise your submission — this form takes you to payment when you send it.

Analysis begins once all four are done, and the report is emailed to you 3 to 4 weeks from the day we receive your sample. Full collection instructions are on the hair mineral testing page.

About you

Use the same name when you pay. That is how your questionnaire, your sample and your payment are matched to each other — so if the card is in someone else's name, put your own name here and pay under it too.

Leave this blank if you have not paid yet — payment is the next step, and most people get here before it. If you have already paid, the reference starts with BH- and is at the top of your receipt email.

This is where the report is sent.

Only used if something about the sample needs sorting out before it goes to the lab.

Worth filling in — painting, welding, panel beating, ceramics and plumbing all come with everyday exposures the report may pick up.

The laboratory holds different reference ranges, so it changes how your numbers are read.

Your hair sample

These five answers are the ones that decide whether a result can be read at all. Treated hair and mineral shampoos both change the numbers, and a laboratory that knows about them can say so on the report.

Anti-dandruff and mineral-based formulas leave selenium and zinc on the strand — two of the elements being measured.

Both are on an earlier report, if you have one to hand. They let the laboratory read this result against your last one instead of on its own.

Anything your hair has had done to it (optional)

Tick everything that applies.

Medications and supplements

Supplements matter as much as prescriptions here. A zinc tablet moves the zinc reading, and a report read without knowing about it says something quite different.

Medical history (optional)
General healthNone
Muscles, bones and jointsNone
Heart and circulationNone
Digestion and liverNone
Kidneys and bladderNone
Nerves and brainNone
Mood, behaviour and memoryNone
Hormones and thyroidNone
Male reproductive healthNone
Menstrual and reproductive healthNone
Why you are testing

The single most useful box on the form. Whoever reads the report reads this first.

Asked because some vaccines contain aluminium, which is one of the elements the analysis measures.

Before you send this

Before you send this

Or call (03) 9380 8099 and do it over the phone.

What happens to your answers

They go to the clinic and to the practitioner reading your report, over an encrypted connection, and they are not sold or shared outside the practice. Your confirmation email says only that the form arrived — it does not repeat what you told us, so nothing sensitive is sitting in your inbox.

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