Practitioner Wholesale Shipping Request Form
For health practitioners who currently have a wholesale account with us. For all other health practitioners wishing to place an order, please call 845 687 6211 to set up an account.
Practitioner phone number:
Ship to Name and Address:
Shipping email address:
What email address should we send shipping notifications to? (We recommend the patient's email address)
Any additional products:
What would you like us to do in the case of item/ingredient unavailability?
I wish to be contacted via phone or email to choose my own substitute herbs or products. I understand that choosing this option may delay shipping while NLHC waits to hear from me about my order.
I wish for the on-duty clinic practitioner (usually Hillary) to choose subs for unavailable products or herbs in my formulas, and send out the shipment as soon as possible. I will be notified of any formula changes by email.
Dosage instructions for patient:
Include NLHC patient handouts?
Herb cooking instructions
Liposomal remedy information
Any special shipping or billing instructions?
NLHC charges a flat $10 minimum shipping fee for any order. Orders that cost more than $10 to ship will result in a charge for actual shipping costs.
I understand and agree to these terms.
Please double check your order before submitting.
Errors such as typos or lack of quantity of products requested will delay your order as we reach out to you for clarification.
FOR OFFICE USE ONLY
__ Charge Wholesale
__ Make Product/Gather Product
__ Print Label
A copy of your responses will be emailed to the address you provided.
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