Academy for Five Element Acupuncture
Chinese Herbal Clinic
Online Patient Payments: Herbal Formulas and Telehealth Appointments

Your practitioner will provide you with the price of your formula. The dispensary will not fill your formula without payment. There are no refunds for custom herbal formulas. Custom herbal formulas cannot be returned or exchanged.

Herbal Formulas
Bulk Formula
Enter your payment amount in the box provided
Granular Formula
Enter your payment amount in the box provided.
Qty
Description
Amount
Total

$16.10
---

$9.42
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Appointment Fees
Qty
Description
Amount
Total

$50.00
---

$25.00
---

$30.00
---

$40.00
---

$25.00
---

$30.00
---
Total: $0.00
Future Commitment: $0.00

*By selecting the Shipping Fee, you are agreeing that you would like your Herbal Formula shipped directly to you.
If you would prefer to pick your order up in person, do not select the shipping fee, instead, check the box below stating that you will be picking up your order.

Please note if patient is different from payer.

I will be picking up my order.
A receipt will be e-mailed to this address.
Your Payment Information

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