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Home / Health Resources / Herbal Dispensary / Herbal Dispensary Order Form

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Herbal Dispensary Order Form

Instructions for Submitting an Online Order 

In order for us to process an online order, we need to have both your Safety Order Form and Billing Information on file.  If you have placed an order with us in the past, you can assume we have this data.  If not, please download and complete both of these forms (see Required Forms section at the bottom of this page) and then use the upload function in the Form Submissions section.

 

To complete the Safety Order Form for new clients, click here

To complete the Safety Order Form for non-herbal students, click here.

To complete the Safety Order Form for herbal students, click here

 

To complete the Customer Billing and Shipping From, click here

 

Please reference our lists of the herbs that we carry before formulating: 

Extracts (updated 5/2/2016) 

Bulk Herbs & Powders (updated 5/2/16)

Custom Powder Policy (updated 1/16/2015)

Resale Products List (updated 2/6/2015)

 

Order Information
First and last name
Please write the daily dose and instructions for clients. For single extract orders, please use the recommended use of the manufacturer.
Please write formula in descending order based on the quantity of each herb. Please include Latin or common names of each herb and the plant part. Please write your formula in either grams or mls. The ratio of each herb should add up to the total amount.
Additional Items
Please write the daily dose and instructions for clients. For single extract orders, please use the recommended use of the manufacturer.
Please write formula in descending order based on the quantity of each herb. Please include Latin or common names of each herb and the plant part. Please write your formula in either grams or mls. The ratio of each herb should add up to the total amount.
Please write the daily dose and instructions for clients. For single extract orders, please use the recommended use of the manufacturer.
Please write formula in descending order based on the quantity of each herb. Please include Latin or common names of each herb and the plant part. Please write your formula in either grams or mls. The ratio of each herb should add up to the total amount.
Refill Orders
If you are a Client, fill in the Formula name and Code listed on your bottle or bag with the practitioner's name and information. If you are a Practitioner or Student/ Alumni, write out the entire formula with the details included in the initial formula. List the date of the original formula and the new refill date.
Form Submissions
Upload the completed safety order form here.
Upload the completed safety order form here.
Upload the completed safety order form here.
Upload the completed form here.