AT3 General Information Form
(If you were referred by someone please let us know.)
{Maximum 1000 Characters - Only what is visibly showing will print.}
Please attach additional information if needed.
*Note:
If you are *not* referred by a doctor,
you *must* sign and return the » Consent and Release Form
Send completed forms with saliva sample and check or money order payable to Dog Patch / Joyce Tasker for $295.00 for complete analysis.
The self test fee includes screening, products, shipping and handling and support. Fee must accompany sample.
- Product refills are an extra charge
- International shipping charged at actual cost
- Non-tincture products additional charge
Pre-paid screenings are available.
3 screenings per individual client $800.00 (savings of $85.00)
Please send to:
Joyce Tasker
Energieswork.com Business Office
2279 Marble Vly Basin Rd.
Colville WA 99114-9575
Email: energieswork@gotsky.com