AML: Order form (TOX/FIB) (V5: EN/CHF) (Eyal, 20/2/2026)

Clinic and invoice
Clinic name*
EmailPost (including surcharge: 10.00 CHF)
Email (to receive the invoice)*
example@example.com
ClinicPatient
YesNo
Email address for order confirmation
Patient information
Patient name*

First nameLast name
Email
Full address*
Postal code*
City*
Country*
GermanEnglish
MaleFemaleOther
Date of birth*

DayMonthYear
Comments (optional)
Analysis type
TOXAMINATION®FIBRISCORE®
Sample information
EluateEDTA whole blood
Before treatmentAfter treatment
Treatment number
Date of sample collection*

DayMonthYear
Panel analyses

(Please check the desired one. Prices include VAT)
Full analysis package (573.29 CHF). Heavy metals complete package, environmental toxins part 1+2 (8 ml sample required!)Select specific packages
Complete package (220.88 CHF). Parameters: aluminum, antimony, arsenic, barium, bismuth, cadmium, cesium, chromium, cobalt, copper, gadolinium, gallium, gold, indium, iridium, lead, manganese, mercury, molybdenum, nickel, palladium, platinum, rubidium, silver, strontium, tantalum, tellurium, thallium, tin, titanium, uranium, vanadium, zinc, zirconiumSmall package (77.61 CHF). Parameters: aluminum, cadmium, cobalt, copper, gold, indium, iridium, lead, mercury, molybdenum, palladium, platinum, silver, tin, zinc, zirconiumNo package
Aluminium (26.51 CHF)Antimony (22.09 CHF)Arsenic (37.75 CHF)Barium (22.59 CHF)Bismuth (38.15 CHF)Cadmium (23.49 CHF)Caesium (18.07 CHF)Chromium (24.00 CHF)Cobalt (27.51 CHF)Copper (31.32 CHF)Gadolinium (50.00 CHF)Gallium (36.14 CHF)Gold (38.85 CHF)Indium (23.59 CHF)Iridium (34.64 CHF)Lead (29.62 CHF)Manganese (35.14 CHF)Mercury (21.89 CHF)Molybdenum (29.32 CHF)Nickel (37.45 CHF)Palladium (32.13 CHF)Platinum (28.11 CHF)Rubidium (36.24 CHF)Silver (27.21 CHF)Strontium (46.38 CHF)Tantalum (23.19 CHF)Tellurium (29.62 CHF)Thallium (34.34 CHF)Tin (31.32 CHF)Titanium (32.33 CHF)Uranium (37.05 CHF)Vanadium (31.32 CHF)Zinc (34.44 CHF)Zirkonium (29.22 CHF)
Complete package (176.20 CHF). Pesticides: aldrin, chlorpyrifos, chlorthalonil, dichlorfluanid, dieldrin, endosulfan, hexachlorbenzol, α/β/γ-hexachlorcyclohexan, heptachlorepoxid, pentachloranilin, p-p-DDE, p-p-DDT, tolylfluanid. Insecticides (pyrethroids): cyfluthrin, cypermethrin, deltamethrin, permethrin. PCBs: 101, 138, 153, 180Select specific packages or individual environmental toxins (part 1)
Pesticides and insecticides (126.05 CHF). Pesticides: aldrin, chlorpyrifos, chlorthalonil, dichlorfluanid, dieldrin, endosulfan, hexachlorbenzol, α/β/γ-hexachlorcyclohexan, heptachlorepoxid, pentachloranilin, p-p-DDE, p-p-DDT, tolylfluanid. Insecticides (pyrethroids): cyfluthrin, cypermethrin, deltamethrin, permethrinPCBs (Polychlorinated biphenyls) (105.12 CHF). PCBs: 101, 138, 153, 180
Aldrin (25.10 CHF)Chlorpyrifos (27.91 CHF)Cyfluthrin (32.13 CHF)Cypermethrin (30.62 CHF)Dichlorfluanid (28.11 CHF)Dieldrin (26.20 CHF)Deltamethrin (26.51 CHF)Endosulfan (26.20 CHF)Heptachlor epoxide (26.51 CHF)Heptachlor benzene (26.51 CHF)α-HCH (27.41 CHF)β-HCH (27.41 CHF)γ-HCH (27.41 CHF)Pentachloro aniline (34.24 CHF)Permethrin (34.44 CHF)p-p-DDE (38.45 CHF)p-p-DDT (41.36 CHF)Tolylfluanid (37.45 CHF)
Complete package (176.20 CHF). Benzene type/BTEX: benzene, ethylbenzene, trimethylbenzene, toluene, xylene. Alcohol and ketone type: acetone, 1-butanol, 2-butanol, i-butanol, ethanol, methyl ethyl ketone, methylisobutyl ketone, 1-propanol, 2-propanol. Halogenated hydrocarbons: dichloroethene, dichloromethane, tetrachloromethane, trichloroethane, trichloroethene, trichloromethaneSelect specific packages or individual environmental toxins (part 2)
Halogenated hydrocarbons (91.77 CHF). Dichloroethene, dichloromethane, tetrachloromethane, trichloroethane, trichloroethene, trichloromethaneAlcohol and ketone type solvents (86.65 CHF). Parameters: acetone, 1-butanol, 2-butanol, i-butanol, ethanol, methyl ethyl ketone, methyl isobutyl ketone, 1-propanol, 2-propanolBenzene/BTEX type solvent (82.63 CHF). Benzene, ethylbenzene, trimethylbenzene, toluene, xylene
Acetone (37.15 CHF)Benzene (29.72 CHF)1-Butanol (27.31 CHF)2-Butanol (29.32 CHF)i-Butanol (22.19 CHF)Dichloro ethene (23.49 CHF)Dichloro methane (24.80 CHF)Ethanol (17.87 CHF)Ethyl benzene (35.44 CHF)Methyl ethyl ketone (25.35 CHF)Methyl isobutyl ketone (33.53 CHF)1-Propanol (26.30 CHF)2-Propanol (29.92 CHF)Tetrachloro methane (34.44 CHF)Toluene (28.81 CHF)Trichloro ethene (35.14 CHF)Trichloro methane (31.43 CHF)Trimethyl benzene (26.10 CHF)
Amyloid Fibrin Microclot and Microparticle Analysis

548.50 CHF (including VAT and transport). Please send 2x Citrablood tubes.
Date of sample collection*

DayMonthYear
Clinical information
YesNo
YesNo
YesNo
Schedule a sample pick-up
Please select a pick-up date and time in your local time zone. Pick-ups are available Monday–Thursday between 09:00 and 17:00.

Please note: When scheduling a FIBRISCORE pick-up, please make sure it is sent on the same day the blood was drawn, as it must reach our lab within 24 hours at the latest.
Please select a pick-up date and time in your local time zone. Pick-ups are available Monday–Friday between 09:00 and 17:00.
Pick-up date

DayMonthYear
Pick-up date

DayMonthYear
09:00–12:00 (9 AM–12 PM)10:00–13:00 (10 AM–1 PM)11:00–14:00 (11 AM–2 PM)12:00–15:00 (12 PM–3 PM)13:00–16:00 (1 PM–4 PM)14:00–17:00 (2 PM–5 PM)
Pick-up instructions
(e.g. “sample is in the mailbox”, “left at reception”)
Consent declaration

I/we, the undersigned, confirm that the analyses listed above have been ordered. I/we have been informed about the purpose of the analyses and the associated costs and agree to their execution and invoicing; the undersigned will bear the costs as applicable. I/we consent to the processing of personal and health-related data for the purpose of performing and reporting the analyses. I/we understand that the results are for informational purposes only and do not replace medical diagnosis or treatment. I/we confirm this with our signature(s).
Place*
Date*

DayMonthYear
Patient signature*

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Clinic signature, stamp*

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Ayus Laboratories AG
Bachtobelstrasse 5
8810 Horgen, Switzerland
+41 61 383 70 33
lab.horgen@ayus.health
www.ayus.health
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Clinic and invoice

Patient information

Analysis type

Sample information

Panel analyses

Amyloid Fibrin Microclot and Microparticle Analysis

Clinical information

Schedule a sample pick-up

Consent declaration