Refills

Boise Natural Health Dispensary Refill Requests

Boise Natural Health carries professional grade nutritional, botanical, and homeopathic supplements for our patients. We require at least 24 hours for refill requests. Some products may require an office visit or laboratory work.

Instructions

• Use this form to submit refills of supplements you currently receive from Boise Natural Health.
• This form is not for medical questions. For dosing, prescription, symptoms and scheduling questions please phone the office at 338-0405 and we will be happy to help you.
• Please do not submit credit card information on this form.

Contact Information

First Name: *

Last Name: *

Phone Number: *

Email Address: *

Physician's Name: * select...Joan Haynes, NMDSara Rodgers, NMDElise Hughes, MDEmily Penney, ND

Product 1

Product 1 Qty:

Product 1 Name:

Product 2

Product 2 Qty:

Product 2 Name:

Product 3

Product 3 Qty:

Product 3 Name:

Product 4

Product 4 Qty:

Product 4 Name:

Product 5

Product 5 Qty:

Product 5 Name:

Product 6

Product 6 Qty:

Product 6 Name:

Comments, Questions, Concerns about your refill:

This form is not for medical questions. For dosing, prescription, symptoms and scheduling questions please phone the office at 338-0405 and we will be happy to help you.

PIck Up or Shipping: *

Pick Up

Shipping

• We require 24 hours to refill your request.
• We will email you when your order is ready for pick up or has shipped.
• If your supplements require an office visit or lab work, we will email you about which action is needed.
• Pick Up: Your refill will be available for pick up during office hours (Monday thru Friday 9am - 1pm and 2pm - 5pm.)
• Shipping: We will phone you to  make payment arrangements.

Shipping Address: Street City, State Zip Code

Boise Natural Health complies with the federal privacy requirements in the Health Insurance Portability Account Act. Your protected health information will never be released about you without your prior written consent.