Dobrý den, k možnosti zaslání vzoru na naši adresu je třeba nejdříve vyplnit následující dotazník. Po jeho vyplnění se Vám zobrazí další instrukce. :)
Hello, please fill in the following questionnaire. After you have done that, you will see further instructions and an address where to send the sample :)

Most fields are not strictly required. Feel free to only fill what you know and what you are comfortable with sharing. Still, especially if the sample is suspicious or has already caused you health issues, any additional information can help others.

Form for a mail-in sample

⚕ Health information

Gender*:

Age*:

Sample already used:

Psychotropic substance use frequency:

🧪 Sample description

What should this sample contain*:

Sample description:

📱 Sample origin

Sample source*:

Sample procurement date:

Sample cost [EUR]:

Approximate place of procurement

🗨 Anything else?

Other information

The form will lock itself after submission, so that it doesn't change while staff is analyzing the sample. Once you filled everything you wanted, please click Confirm.