Do you have PDF versions of your Application Form and Medical Document?


Application to Become a Patient of Herbal Dispatch

You can complete your registration by creating an account on our website, and then completing the online submission form in your My Account area, OR you may alternatively fax or email any of the Application Forms below to:

Fax: 1-833-245-9991

Email: [email protected]

Application Type Download Link
Applicants with a Residence
Applicants without a Residence
Applicants shipping to Practitioner

Medical Document

Your practitioner may use their existing Medical Document template, OR you can have them complete and fax the PDF below to our secure fax line: 1-833-245-9991

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