Custom Product Request Form

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Please complete this form for your custom product request and we will contact you as soon as possible to go over details and availability before the order is finalized.

Upon finalization of your order, we will have the product ready the following business day (unless specifically indicated otherwise) for pick up or will have it shipped as soon as possible.

Please allow us up to 2 business days to respond to any custom product requests. Thank you for your patience, we look forward to working with you!

First & Last Name *

Phone Number *

Email Address *

Preferred Method of Contact *

Phone

Required

Type of Product *

Tincture

Oil

Essential Oil Blend

Tea

Other:

Required

Was This Product Recommended by a Health Care Practitioner (Naturopath, Nutritionist, Herbalist, Midwife, etc)? *

Yes

Do you agree to seek the advice of a Health Care Practitioner prior to use of this product should you not have already done so?

Yes

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Please Describe Your Product to Us (Include as much Detail as Possible, such as Ratios/Formulas, Ingredients, Size, Amount, etc). *

Please Let Us Know of Any Prescriptions or Pre-Existing Health Conditions That May Be Relevant *

Preferred Method of Delivery *

In-Store Pickup (Free, 1-2 Business Days)

Shipping (Cost Calculated Upon Finalization, 7-10 Business Days)

Submit

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