Name (as given at your consultation) *

First Name

Last Name

PRESERVATION METHOD

Choose ONE preservation method for your formula. If no preference is selected the formula will be preserved with the standard brandy. ⊹ Glycerine reduces the number of drops in a bottle due to its viscosity. ⊹ Raw Apple Cider Vinegar may become cloudy over time. This is normal and not harmful. ⊹ None and Apple Cider Vinegar are NOT RECOMMENDED FOR SHIPPING. Please note the weather conditions for your chosen shipping time and location when choosing preservation methods. Avoid heat exposure. Choose alcohol preservation if there is a risk of extreme cold exposure.

Demeter Certified Biodynamic® Local Artisanal Brandy (Recommended)

Demeter Certified Biodynamic® Raw Apple Cider Vinegar (Refrigerate)

Organic Vegetable Glycerin (Sweet)

None (Refrigerate immediately & use within 21 days)

BOTTLE TYPE

If no selection is made the Remedy Refill will come in the standard 1oz dropper bottle. ⊹ 1 oz Amber Dropper Bottles contain approximately 4 weeks of non-glycerine preserved remedy when used in standard dosage of 4 drops, 4 x daily. ⊹ Spray Bottles provide discrete dosing, easy topical and ambient application, and help prevent unintentional contamination of remedies. ⊹ Two 1/2 oz Dropper Bottles fit more easily in pockets and can be kept in multiple places for convenient dosing (at home & away).

1 fl.oz / 30 ml. ℮: Amber Glass Bottle with Glass Dropper (Standard)

1 fl.oz / 30 ml. ℮: Amber Glass Bottle with Spray Top (Approximately 30 sprays per bottle)

Two 1/2 fl.oz / 15 ml. ℮: Amber Glass Bottles with Glass Droppers (Additional $2.50 bottle charge)

Delivery Method *

Local Pick-up

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