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We’d love to hear from you!

We’ll get back to you as soon as we can; but please bear in mind we are an organisation run by volunteers. We appreciate your patience.

First Name

Last Name

Phone

What can we help you with?

What type of IGeneX test kits do you require?

Blood Collection Kit

Urine Collection Kit

Blood AND Urine collection kits

How many of EACH IGeneX kits do you require?

eg. If you require two blood kits and two urine kits - type 2

How many Armani kits do you require?

Is this for an event?

Yes

This request is for a

Date of event

In order for us to be of the best support to your efforts, please outline the number of brochures required and how you will be using them

Tell us more about how you'd like to contribute:

Please describe why you'd like to be assessed for Lyme and associated infections including how long you've been unwell:

Address

City / Suburb

Please select your state

Postcode

We don't always hold details for physicians in every state/territory, would there be another state/territory you are willing/able to travel to? If so, please select one below.

Other

Would you like to subscribe to our Newsletter?

Yes

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