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*Indicates Required Fields

Address Information

First Name:*

Last Name:*

Address:*

City:*

State/Province:*

Country:*

Zip/Postal Code:*

Phone Number:*

Email Address:*

Prescription

Are you sending a :

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:

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).

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