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.
Email address *
Practitioner name: *
Your answer
Practitioner phone number: *
Your answer
Ship to Name and Address: *
Your answer
Shipping email address: *
What email address should we send shipping notifications to? (We recommend the patient's email address)
Your answer
Product 1. *
Your answer
Product 2.
Your answer
Product 3.
Your answer
Any additional products:
Your answer
What would you like us to do in the case of item/ingredient unavailability? *
Dosage instructions for patient:
Your answer
Include NLHC patient handouts?
Any special shipping or billing instructions?
Your answer
NLHC charges a flat $15 minimum shipping fee for any order. Orders that cost more than $15 to ship will result in a charge for actual shipping costs. *
Required
A copy of your responses will be emailed to the address you provided.
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