TCM FormulasTM
Personalized Chinese Herbal Formulas
 
 

Student Liquid Order For Self

4 Easy Steps to Order Herbs from TCM Formulas TM

 
Step 1: Who and Where
 
Intern:
Your Phone #:
Formula #:
 
(For quick refills)
 
If you are ordering a refill, do not use this form;
instead, consult the help screen for quicker, easier methods.
 
Shipping
Information
Patient Address
City
 
Delivery to me ($4.95)
Pickup at PCOM SD
Zip code:
Patient Phone:
       
     
 
Step 2: Duration and Daily Dosage
 
 
Bottle Size:
2 ounces 4 ounces
 
The daily dosage is:

droppers
times per day
     
 
 

Step 3: Herbal Formula

  • Choose the liquid extracts you want to combine, and the proportion in which to combine them
Liquid Combo Name: (for quick refills!)
       
Choose Formula by Pinyin or English
Select Proportion
1
Entire Bottle
2/3 1/2 1/3
2
1/3 1/2 0
3
1/3 0
     
     
 

Step 4: Grand Total & Order
 
 
Total Formula Cost:
 $

If you change anything, be sure to click "Grand Total" again before ordering.
 
Shipping Charge:
 $
 
California Tax:
$
  Click for

$

 
 
 
Double check the whole form, and then click Order to email your order:
Your mail program may ask for confirmation- go ahead and send us the email.
You will see a confirmation window pop-up; check to see if it opened under this window.
 
 
 
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Message Center/FAX: (877) 283-0678