[vc_row][vc_column] *Indicates Required FieldsAddress InformationFirst 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 IslandQuebecSaskatchewanYukonCountry:*-- Select --United StatesCanadaZip/Postal Code:*Phone Number:*Email Address:*Prescription Are you sending a :NEW prescription or aREFILL request to be processed with this order?Special InstructionsPreferred method of contact for clarification:EmailTelephonePreferred method of contact for processing:EmailTelephonePreferred method for payment:Credit cardCash** Cash payment is only accepted for instore pickups and refillsRefills 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 remedyBrand: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 tabletsPlease 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).[/vc_column][/vc_row]