Click to Print  and send with hair sample and check, money order or Credit Card                                                                                              
Rhonda Lyons, ND
Hair Analysis
27  Union Jack Street
Marina Del Rey, CA 90292

 If you need to speak with Rhonda Lyons please call 
323-325-8681
or
You may click HERE to e-mail questions

Instructions -          

Take the sample from the back of the head
-  Ideally out of the first 2.5 to 5cm
-  Take a large enough amount! Min. 0.5 grams (approx.1 teaspoon)
-  Only use rust-free scissors
-  Hair must not have been chemically treated in the last 2 weeks (perms, coloring, etc.)
-  Send your hair sample in a second envelope inside the first envelope (do not sent in aluminum foil or   ....saran wrap!)  
-  You may cut pubic hair instead of head hair (150 milligrams.) ( 1 tablespoon )    
         ( Please write "pubic hair" at the top of the order form.)  - Enclose payment with Hair sample

 Statements regarding the Client

Age ________          q male  q female

 (If female: Pregnant?  q Yes   q No)

 Brand of shampoo ________________

 Natural hair color _________________

 Color-treated hair?    q Yes    q No  
  Pubic hair?             q Yes    q No

First Name __________________________

Last Name  __________________________

Address  ___________________________

City __________________ State ___ ZIP ____________

 Phone _______________________

 E-Mail ____________________________________

 US$ 159.00 (+ US$ 8.00 priority shipping and handling):  Make Checks Payable to Dr. Rhonda Lyons

We Accept all credit cards:

Name on Credit Card: ___________________________________________________________  

Address on Credit Card: _________________________________________________________

City on Credit Card: ____________________________ State _____ ZIP __________________

Phone on Credit Card: ________________________________

Credit Card Number:  ________________________________________________

3 or 4 digit security Number on front or back of card:  __________________________

Signature:________________________________________________________________________