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Test Sample Request Form

Important!

We are constantly developing safe mew products in the treatment of psoriasis and eczema. We have completed initial tests on a number of products in the treatment of psoriasis, eczema and acne. We are inviting people that suffer from (plaque) psoriasis, eczema and acne to test our products. We provide the product free of charge to you (possibly you pay only for the postage). All we ask you to do is to request a free test sample (in the case that you either suffer from psoriasis, eczema or acne)  using the form below complete with your name and address/delivery details PLUS a current photo of your current condition. You also promise you will complete our test-questionnaire during and at the completion of your test AND another then photo of your then condition.

NB: Our products do not contain any (cortico)steroids, no coal tar and no other harsh chemicals. Your application will be handled with your privacy guaranteed.

Use this form also to request test sample. Comments or questions are welcome. Your address details are required to mail the test sample to. Allow for several weeks for the sample to arrive.

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Test Sample Request Form
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