ExperTox Inc. Analytical Laboratory

1803 Center St., Suite A

Deer Park, Tx. 77536

281/476-4600

281/930-8494 FAX

1. A urine sample of the first morning urination should be placed in a sterile collection vial. Sterile collection vials may be purchased at any medical supply house.

2. A chain of custody form should be completed by the patient. This form may be downloaded from the Internet at www.expertox.com. Put an X by Heavy Metals and write in Platinum.

3. The urine sample vial, along with a similar empty vial (for blank correction), and the completed chain of custody form should be shipped in a small cardboard box containing blue ice for temperature control during overnight shipment.

4. Please exercise caution in ensuring that the specimen vial is securely sealed (can be placed inside a zip lock bag), in order that accidental leaks do not occur during shipping and void the testing.

5. Complete the questionnaire to be included in the research project.

6. Place the questionnaire and a $150.00 cashier’s check in the shipping box.

7. The results of your testing will be mailed to you at the address you have included in the chain of custody form unless you indicate other instructions.

8. For any further assistance with this collection protocol, do not hesitate to call ExperTox at 281/476-4600.

Have you ever been treated with platinum-based chemotherapy drugs, for example cisplatin, carboplatin, and/or iproplatin? _____yes _____no If yes, how long was your treatment? __________ How long since last exposure?____________

Have you ever worked in an industry that used chloroplatinic, or hexachloroplatinic acid?

_____yes _____no If yes, how long was your exposure?___________ How long since last exposure?____________

Have you ever made platinum jewelry? _____yes _____no If yes, how many months or years did you make platinum jewelry?_____________ How long since last exposure?

_____________

Have you ever been in an occupation where you were exposed to heavy amounts of car exhausts? For instance roadside worker? _____yes _____no

Other____________________________ _____yes _____no

If yes, how long did you work in this occupation? _______________ How long has it been since you worked in this occupation? ________________

Have you or members of your household worked in any capacity in a muffler shop or other automotive type of business? ________yes ________no If yes, how many years were you or they employed in this occupation where you might have inhaled dust either directly or from handling of their clothing?___________ How long has it been since you or they worked in this occupation?_____________

Do you know if you have any dental amalgams that include platinum?____yes_____no

Don’t know_________If yes, how many teeth contain platinum amalgams and how long have they been in your mouth?_____________________

What implanted devices have you had in your body. Please list year implanted with manufacturer, type of implant (if breast implants please list type such as saline, silicone gel, double lumen, and if textured), any identifying markers (serial, lot number, etc.), year removed if no longer in your body, and status of implant when removed (for instance ruptured, intact but with heavy "leaking" of gel indicated, etc.)

If you need additional space, please use back of paper.

1.Year implanted______ Type of implant______________________________________

Manufacturer of Implant (if known)___________________________________________

Identifying Markers_______________________________________________________

Still Implanted with this device? Yes_______ No______ If no, year explanted_________

Status of Implant when removed_____________________________________________

2.Year implanted_____ Type of implant_______________________________________

Manufacturer of Implant (if known)___________________________________________

Identifying Markers_______________________________________________________

Still implanted with this device? Yes_______No_______If no, year explanted_________

Status of implant when removed______________________________________________

List the year you were explanted (if explanted) with no implant reinserted__________

Was your implant removed "en bloc" (implant and scar capsule removed as a unit)?

Yes_____No.______ Was your scar capsule left inside your body? Yes_____No____

Have you done any detoxing to remove heavy metals from your body? Yes____No___

If yes, please indicate method and period of time used.___________________________

Have you had any children born after implantation? Yes_____No______

If yes, how many years were you implanted before your children were born?__________

Please list number of years implanted for each child being tested.

I hereby give my voluntary consent for platinum testing of my urine sample and release of the test results by ExperTox Inc. to S.V.M Maharaj and Chemically Associated Neurological Disorders (CANDO) to be included in CANDO Research Project #2. I understand that my name will not be identified in any published research as a result of this testing. I further agree to hold ExperTox Inc.; its agents, directors, officers or employees as well as S.V.M. Maharaj, Ph.D. or CANDO harmless from any and all liability or negative effect on any pending litigation regarding the manufacturer of implanted devices.

Name__________________________

Social Security #_________________

Address________________________

_______________________________

Phone Number___________________

e-mail address____________________

Please send one copy of this questionnaire to ExperTox with your sample to be tested.

Send a duplicate copy to Chemically Associated Neurological Disorders (CANDO)

P.O. Box 682633, Houston, Tx. 77268-2633. If you have questions call 281/444-0662

To read letter explanatory letter from Marlene Keeling of CANDO, click here:

FastCounter by bCentral..

HOME SUPPORT GREATLINKS QUACK LIBEL VICTORY DEFAMATION CASE PUBLIÇATIONS DAILY NEWS