Hair Strand Test Collection Instructions Form
Use this form to collect the details needed to provide and confirm hair strand sample collection instructions for a hair test.
Participant Information
Full Name
*
First Name
Middle Name
Last Name
Phone Number or Email Address
*
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Collection Details
Test Type or Sample Purpose
*
Self-collection
Salon/Professional collection
Assisted collection
Other
Preferred Collection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Collection Time
Hour Minutes
AM
PM
AM/PM Option
Was the Hair Washed Within the Required Timeframe?
*
Yes
No
Hair Sample and Instructions Confirmation
Hair Length and Condition Notes
Can you provide the required amount of hair strands?
*
Yes
No
Special Collection Notes or Questions
I understand and will follow the hair strand collection instructions provided.
*
I understand and will follow the instructions.
Submit
Should be Empty: