Health Form

Good State's Health Solution Form

Step 1 - Please read carefully

Your Hair sample cannot be dyed, colored or treated in anyway. If your hair is dyed or treated, please wait for new virgin hair growth. The second option is to send pubic hair. (Pubic hair is not as accurate as hair, but can show good information). Nail clippings is the last option. It is the least effective of the 3 options.

Step 2
Please collect 150 mg or about 1 Tablespoon of hair (paper scale provided). See diagram for best source of hair. 
Collection Area
Step 3
Put your hair sample in a small paper envelope (provided). Then mail your hair sample using the free Business Reply Mail (provided). 

GoodState Inc. 
Atten:Hair
435 Pennsylvania Ave. 
Fort Washington PA, 19034-9910

Step 4 - Complete Form







Date of Birth













Please select all issues that apply to your body 
If there is an issue that relates to your body, please rate your issue from 1 thru 5.
1 = Small Issue
2 = Medium Issue
3 = High Issue
4 = Very High Issue
5 = Major/Extreme Issue
1 2 3 4 5



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