Tea Blend | Herb Order Form

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Please use this form to place your order for a bulk herbs, teas, or special blends for yourself or patients/clients.

Vervain will confirm the order via email or phone, make the order, label with any provided instructions, and notify you or your patient/client when it is ready to pick up.

To view our list of herbs, please view the "List of Bulk Herbs|Tinctures|Teas|Blends" document:
https://docs.google.com/spreadsheets/d/1r-ha47S_Yk4w4j0zrG6LOf2sicl0pzIQxyPBb6Z47PU/edit?usp=sharing

Email *

Ordered By (specify "self" or "practitioner") *

Phone number of person ordering (in case we have questions) *

Email of person ordering (in case we have questions) *

Patient/Client Name (if practitioner order) *

Patient/Client Phone Number *

Patient/Client Email *

Custom Tea Blend: list tea ingredients. Please check our list of herbs linked above to make sure we carry them.

Custom Tea Blend: state the recipe/proportions

Equal parts by weight (we'll use 0.5 or 1 ounce depending on herbs)

Equal parts by volume (we'll use 0.5 or 1 cup depending on herbs)

Other:

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Custom Tea Blend - Please provide any instructions you want us to write on the label.

Custom Tea Blend - Are there any limitations on refills (i.e. patient must see you again before getting a second batch)?

Bulk Herb, non-custom Tea Blend, or Special Blend Order - Please list bulk herbs or special blends needed and amounts. Please check the spreadsheet above to make sure we carry them.

A copy of your responses will be emailed to the address you provided.

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