This form is for practitioners with an active license or registration number only.

If you are not a practitioner, please refer to our General Order Form.​

If you have not yet been approved to use our Botanical Compounding Dispensary, please submit your application here FIRST.

To place an order, please fill out all required form fields with as much accuracy and detail as possible. Missing or incomplete information may cause processing delays.

For all other inquiries, please contact apothecary@ancientoriginsmedicinals.com