Consent Form User Signature

Thanks for enrolling!

To test your bulk tank milk, we need a few more details and your consent for MilkTestNZ to release samples from your farm(s) to Farm Medix*.

*If your supplier is not yet part of the program, one of our partners will reach out to you to organise milk sampling at your farm.

Simply fill out the form below and we will get your test underway



I, of ,

- Contact Tel:
- Contact email:
- TOTAL No. Samples requested:


Hereby request release of samples from the above farms for further testing (bacteriology) to Farm Medix Ltd, of Waikato Innovation Park, Melody Lane, Hamilton.

Tel: 07 958 9978


By signing this request you confirm your details match those held by the Dairy Company you supply to, and that you hold authority to request testing on your farm.


Full Name

Sign Here