If you are unable to submit the form electronically, you can print it out here:
Fill in your information, scan, and email back to us at HairAnalysis@GoHealthyNext.com. You may also fax it to us without a cover sheet to (866) 370-7199. We do not accept printed and mailed copies of the forms.
You only need to fill out this form once.
Gmail users may experience issues receiving a confirmation code to verify their email, and can add a filter to enable Jotform notifications. View this tutorial for directions on how to do this.