Compounding Apothecary Request Form for Clients
This form is for people who would like MXED GREENS to fill herbal formulas for your own use, often a formula that was created for you by a Clinical Herbalist, or a formula/recipe you found in an herbalism book. If you are an herbal practitioner and would like to request a formula be filled for one of your clients, please use our other google form "Compounding Apothecary Request Form for Practitioners."
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Email *
Compounding Apothecary Procedures:

Once this form is submitted, you will receive an email to confirm that your formula(s) have been received as well as an invoice for the sliding scale price you have indicated + shipping. Once the invoice is paid (via paypal or venmo), your formulas will be filled and either shipped or ready for pickup at MXED GREENS in Easthampton, MA.
If we are out of an ingredient in your formula request, we can suggest substitutions!
Your name + contact info *
How would you like to get your herbs? *
If you selected "ship" please provide a shipping address. shipping will be calculated based on weight of formulas - generally its $11 or less for the East coast, and $15 or less for West coast.
Formula Request: 
1. Please specify Extract, Bulk Herb, or Powder
2. Ratio of Ingredients (in parts or percentages). Extracts are assumed to be tinctures; please specify if any ingredients are glycerites.
3. total volume requested in oz
4. Any dosing instructions to be written on bottle (~10 works max) or bulk herb bag (no word limit)

Examples:
1. Extract
2. 2 skullcap, 2 passionflower, 1 chamomile glycerite
3. 5 oz
4. take 1/2 tsp 30 mins before bed, 1/2 tsp at bedtime

1. Bulk Herb
2. 2 tulsi, 1 gotu kola, 1/2 peppermint
3. 2 oz
4. 1  TBS/8 oz hot water, steep 10 mins. drink 1 quart or 4 cups daily.
 *
Additional Formula Request
 
1. Please specify Extract, Bulk Herb, or Powder
2. Ratio of Ingredients (in parts or percentages). Extracts are assumed to be tinctures; please specify if any ingredients are glycerites.
3. total volume requested in oz
4. Any dosing instructions to be written on bottle (~10 works max) or bulk herb bag (no word limit)
Additional Formula Request
 
1. Please specify Extract, Bulk Herb, or Powder
2. Ratio of Ingredients (in parts or percentages). Extracts are assumed to be tinctures; please specify if any ingredients are glycerites.
3. total volume requested in oz
4. Any dosing instructions to be written on bottle (~10 works max) or bulk herb bag (no word limit)
Additional Formula Request
 
1. Please specify Extract, Bulk Herb, or Powder
2. Ratio of Ingredients (in parts or percentages). Extracts are assumed to be tinctures; please specify if any ingredients are glycerites.
3. total volume requested in oz
4. Any dosing instructions to be written on bottle (~10 works max) or bulk herb bag (no word limit)
Sliding Scale Invoice
Please calculate your payment to be invoiced as follows:

(volume of extracts in oz) x (your sliding scale payment per oz  $8-$24) = total

(weight of bulk herbs in oz) x (your sliding scale payment per oz $4-$8) = total

Example:
6 oz tincture x $14/oz = $84
2 oz bulk herbs x 5/oz = $10
total = $94
 *
Thank you for submitting your order!
During our business hours, we will send you an email to confirm your order. We will let you know the total (including shipping cost) to be paid via venmo or paypal. Once payment is received, the formula(s) will be filled and shipped. We respond to emails and pack orders during open hours on Thursday and Saturdays, and ship on Fridays and Mondays. 
- Tasha, MXED GREENS' Clinical Herbalist
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