*Indicates Required Fields Address Information First Name:* Last Name:* Address:* City:* State/Province:* -- US States --AlabamaAlaskaAmerican samoaArizonaArkansasCaliforniaConnecticutDelawareDistrict of ColumbiaFloridaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMicronesiaMinnesotaMinor Outlying IslandsMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorth Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWest VirginiaWisconsinWyoming-- Canadian ProvincesAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Country:* -- Select --United StatesCanada Zip/Postal Code:* Phone Number:* Email Address:* Prescription Are you sending a :NEW prescription or aREFILL request to be processed with this order? Special Instructions Preferred method of contact for clarification: Email Telephone Preferred method of contact for processing: Email Telephone Preferred method for payment: Credit card Cash* * Cash payment is only accepted for instore pickups and refills Refills Requested * - Fields required to be filled for your request. Medication Name:as on label, indicated liquid or pellet form (ex. Arnica pellets) Potency:e.g. 1DH, 6C, 30C, 200CH, 1M, 5M, 10M, etc. Quantity:number of bottles of each remedy Brand:Heel, Boiron, Dolisos, Metagenics, etc. *Medication Name: Potency: *Quantity: *Brand: *Size: -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets -- Select --15 ml30 ml60 ml120 ml250 mlMulti-Dose PelletsSingle Dose pellets125 tablets Please be advised that if the quantity requested does not correspond with our pack sizes, we will fill according to your most recent order, or the closest available pack size. The order you have just submitted will for processing and cannot be changed or stopped once submitted. Please be sure all information you have provided is accurate. A representative will contact you within 2 hours during regular business hours. Please allow up to 2 days for delivery of your order. Free shipping on Canadian orders over $100 (excludes shipping address in the USA).
