KW Botanicals Practitioner Prescription Form

The minimum order for Practitioner Prescriptions is 16 or 32 ounces, varying in accord with the number of herbs in your formula (see table).

If you order an 8 oz. prescription, a $10.00 small size fee applies. We do not fill individualized formulas under 8 oz. You may order an 8 oz. or larger formula & 2 or 4 oz. empty bottles & blank labels, and provide your patients with these smaller sizes.
Larger sizes are priced at a lower cost per ounce.
Please use this form to order your prescription, click the submit button when complete.
We do not process hand written prescriptions or those presented as pdf’s, faxes, or in the text of an email!
Un-modified Refills may ordered with this form. Do Not Re-Submit the Formula for Unmodified Refills – we already have this information! Thank-You!
For ‘standard’ amounts of individual herbs, leave the left column blank. Or: indicate chen, grams, %, or “+” or “–”.
For modifications of TCM formulas, write Pin Yin Name followed by additional herbs desired (refer to our KW Traditional Chinese Medical Formulas Index). If the TCM Formula is not in our Index, provide a reference or type herbs below.
Charges for herbal prescriptions begin at price code 4, and increase in accord with the cost and quantity of herbs used.

KW Botanicals will fill the herbal prescription you provide below.