Custom Order Form
Complete and submit this form if you would like to purchase our Homeopathic remedy kits, specific Homeopathic remedies, Homeopathic charts or other items that you do not currently see available through our online store. If we are unable to fulfill your order or if we have questions, we will contact you. After we receive your request we will send you an invoice via email which can be paid online. Once your payment is received we will process and ship your order as soon as possible. Larger kits & custom orders may take 2-3 weeks to ship. We will send tracking information via email when your order has shipped. If you have any questions, please contact us via email (orders@lotuswellnesscottage.com) or phone (540-745-3662). Thank You!
Email address *
Date of Order Request *
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Name - Person Requesting Order *
Name - Shipping To (If different from above)
Complete Shipping Address (including apartment #) *
Phone Number (best # to reach you) *
Homeopathic Remedy Kits
Include quantity requested in the "other" section. Pricing shown does not include shipping.
Homeopathic Charts
Include quantity requested in the "other" section. Pricing shown does not include shipping.
Other Items Requested
This should include any items not shown above that you would like to request, quantity of each item and potency (if applicable).
Submit
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