Order Your Food Intolerance Evaluations Using a traditional naturopathic technique to cut through the confusion & find the foods that are keeping you from feeling your best. How would you like to receive your kit/sample?(Required) Request by Mail Request an In-Person Appointment with Dr. Liz Carter in West Seattle Please click the link below to request your in-person appointment in West Seattle: Go to https://newleafnaturalmedicine.com/appointments/ and select Food Intolerance Evaluation and then Food Intolerance Sample Collection. You will not need to continue this form. Use the appointment scheduling system instead. Name(Required) First Last Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Terms & Conditions for Food Intolerance Sample Food Intolerance Evaluation Limits Dr. Liz will provide you with a comprehensive results packet detailing your food intolerances. If you'd like help interpreting them, you can book a 30min Food Intolerance Telemedicine Results appointment. Please note that Dr. Liz is happy to answer questions via email or during the telemedicine appointment if you book one about the results. She will not discuss health conditions as that is beyond the scope of the evaluation and follow up. If you would like support for your overall health, please book a full appointment. Thank you! Turnaround Time The turn around time for food intolerance results is 7-10 days after your sample is received. Optional Telemedicine Results Follow Up If you'd like to book a telemedicine results consult, please do so after you've received your results. Payment Due at time of service. Payment will need to be completed in full before your sample kit is sent to you.Do you accept the Terms and Conditions?(Required) Yes, I accept the Terms and Conditions How did you hear about the evaluation?(Required) For whom is the evaluation(s) for? Yourself and/or Other Humans Pet(s) Yourself AND Pet(s) Food Intolerance Evaluations for Yourself and other Humans Quantity(Required) Price: $160.00 Quantity Food Intolerance Evaluations for Your Pets Quantity(Required) Price: $85.00 Quantity How many sets of sample collection instructions do you need?(Required) How many return envelopes do you need?(Required) International Shipping Total Promo Code Credit CardCard Details Cardholder Name
