Remedies Order Form

Use this form to:

  • request or order a repeat of your remedies
  • enquire about the availability or cost of an item
  • arrange pick-up or delivery of the items

First Name:

Last Name:

Are you an exisiting client of Como Natural Medicine?:     Yes     No

Home Phone Number:

Work Phone Number:

Please list the remedies you would like to order, by name or description:
(eg, "Tresos B 50's" or "Herbal mix for nausea")

Select a delivery option:    Pick-Up     Mail to address below
(All mail orders incur a postage and packaging fee of $5.00 [minimum])

Postal Address:

Attention To:

Address Line 1:

Address Line 2:

Suburb:

Postcode:

Additional delivery information:

How would you like to pay?
Call me for my credit card details
Charge my credit card using details you have on file
I will pay when I pick them up

Please check your details carefully before submitting.

Press send ONCE.