Please enter a valid email address (e.g. name@example.com)
All new customers begin with an initial phone call. How would you prefer I follow up after that?
Please select a preferred contact method.
Your Contact Information
Please enter a valid email address (e.g. name@example.com)
Your Pet's Information
All new customers begin with an initial phone call. How would you prefer I follow up after that?
Please select a preferred contact method.
Have you filled out a form with us before?
It looks like you may already have an account with a different email address.
Using the same email keeps all your forms, formulas and progress together in one account. If you remember the email you used before, please change it above — or sign in to your account, or contact Amanda and she'll sort it out.
Wellness History
The more context you share, the better I can tailor your formula.
Please note: I am not a physician. It is always recommended to discuss herbal therapy with your physician before beginning — especially if you take medications or have existing health conditions. You are welcome to continue with your request.
The quickest and best way to do this is to have your doctor reach out to me directly. Please share my contact information with them:
Email: vitalrootsremedies@gmail.com Phone: 615-517-0570
Your doctor's information
Please enter a phone number or an email (or both).
Please note: I am not acting as your pet's veterinarian. It is always recommended to discuss herbal therapy with your veterinarian before beginning — especially if your pet is on medications or has existing health conditions. You are welcome to continue with your request.
The quickest and best way to do this is to have your veterinarian reach out to me directly. Please share my contact information with them:
Email: vitalrootsremedies@gmail.com Phone: 615-517-0570
Your current veterinarian
Optional, but helpful.
Wellness Agreement
Please read and sign the agreement below before submitting your request.
Nature of Services. The herbal formulations and formulation sessions provided by Vital Roots Remedies are intended for education and general wellness support purposes only. They are not intended to diagnose, treat, cure, or prevent any disease or medical condition. Nothing communicated during a formulation session or in any formula documentation constitutes medical or veterinary advice.
Not a Substitute for Professional Care. I understand that these services are not a replacement for care provided by a licensed physician, veterinarian, or other qualified healthcare professional. I agree to continue working with my existing medical or veterinary providers, especially for any diagnosed or suspected health conditions.
Disclosure of Medications and Conditions. I agree to disclose all current medications, supplements, and relevant health conditions for myself or my companion animal. I understand that withholding this information may affect the safety or suitability of the formulation.
Herb-Drug Interaction Awareness. I understand that some herbs may interact with medications. While care is taken to screen for known interactions, the field of herb-drug interaction research is regularly evolving. I agree to notify my prescribing physician or veterinarian of any new herbal supplementation.
Companion Animal Formulations. For formulations involving companion animals, I acknowledge that herbal support is not a substitute for veterinary care. I understand that any formula is provided with the intent of general wellness support, not treatment of any veterinary diagnosed condition.
FDA Disclaimer. These statements and products have not been evaluated by the Food and Drug Administration. These formulations are not intended to diagnose, treat, cure, or prevent any disease.
Results. I understand that individual results may vary. No specific wellness outcomes are promised or guaranteed.
By typing your name above and clicking "Continue," you are providing your electronic signature and agreement to the terms above.
One more form: Health Information Release
Please also review and sign this authorization. It lets me work with your doctor or veterinarian if you'd like to bring them in, now or later.
Authorization to Release Health Information
HIPAA — 45 CFR § 164.508
A signed release is required before I can communicate with any of your healthcare providers. Signing now means I can work with your doctor or veterinarian whenever you choose to involve them. If you choose not to sign, I will not be able to collaborate with your or your pet's healthcare provider.
Recipient / Provider:Healthcare provider (as provided in Step 3)
Information to Be Shared: Relevant health history, wellness goals, current medications and supplements, and any herbal formulas provided — only as necessary to support collaborative wellness care.
Purpose: To allow Vital Roots Remedies and the above-named provider to communicate and coordinate regarding my herbal wellness care.
Expiration: This authorization expires one (1) year from the date signed, or upon my written revocation, whichever comes first.
Right to Revoke: I may revoke this authorization at any time by sending written notice to Vital Roots Remedies. Revocation will not affect disclosures already made in good faith reliance on this authorization.
Voluntary: Signing this authorization is completely voluntary. Services will not be denied if I choose not to sign.
Re-Disclosure Notice: Once information is shared with the recipient, it may no longer be protected by HIPAA and could be subject to re-disclosure.
Please note: without a signed release, I will not be able to collaborate with your healthcare provider or your pet's veterinarian. If you change your mind later, just let me know and I'll send you the release to sign.
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Request Received!
Thank you for submitting your intake information. The next steps are:
📬 Check your email to set up your account
We sent a message to . Click the button in it to confirm your email and create your password. Your account lets you follow each step of your formulation, see your formulas and tracking, and reorder. If it doesn't arrive in a few minutes, check your spam folder.
I will review your form within 1–2 business days and make sure that you are a good candidate for herbal therapy.
Once confirmed, I'll send you an invoice for the initial formulation session and schedule the formulation call with you. During that call we can go over any further questions we may still have, review the goals, and discuss the plan. The phone calls typically take between 15–30 minutes.
In the next 1–3 business days after the call, I will create your herb formula and then send you the invoice for the cost of the formula. Formulas are billed separately from the formulation session costs because each formula has different production costs depending on what herbs go into it. This also simplifies the process for future re-orders.
Once the herb formula payment is received, I will ship it out to you and will send you the tracking information.
You are welcome to use the customer portal to track the current progress of this process, as well as see the custom formula created for you and submit re-orders. Automatic payments and shipping will be an option once you are settled with a formula long term.
Additional Information
If I do not have an herb in stock that is needed for your formula, I will have to order it. That will likely add another 3–5 business days, but I will inform you if that is the case and give you the estimated arrival date of the herb once ordered.
Follow-up communication after the initial phone call will be via text or email (whichever you marked as preferred). I can answer any questions you may have, as well as make minor tweaks to the ratio of herbs in your formula for future batches.
If big formula adjustments are needed, usually due to:
us helping one of the conditions and/or wanting to address a different or new one
new changes in health condition
a change in the priority of issues to address
You can submit a Modify My Formula request, which counts as a follow-up formulation session at a lower cost than the initial one.
For existing customers needing a formula refill. If anything has changed significantly since your last order, I may recommend a brief check-in call before preparing your formula.
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Refill Request Received
I'll review your request and send your invoice.
Once the herb formula payment is received, I will ship it out to you and will send you the tracking information.
You are welcome to use the customer portal to track the current progress of this process, as well as see your custom formulas and submit re-orders. Automatic payments and shipping will be an option once you are settled with a formula long term.
Additional Information
If I do not have an herb in stock that is needed for your formula, I will have to order it. That will likely add another 3–5 business days, but I will inform you if that is the case and give you the estimated arrival date of the herb once ordered.
Follow-up communication will be via text or email (whichever you marked as preferred on your initial form). I can answer any questions you may have, as well as make minor tweaks to the ratio of herbs in your formula for future batches.
If big formula adjustments are needed, usually due to:
us helping one of the conditions and/or wanting to address a different or new one
new changes in health condition
a change in the priority of issues to address
You can submit a Modify My Formula request, which counts as a follow-up formulation session at a lower cost than the initial one.
For current customers whose wellness needs have changed significantly and whose formula needs a full revisit — not just a refill. Share what's changed and I'll reach out to go over everything before crafting your updated formula.
🌿
Modification Request Received
I will review your form within 1–2 business days and come up with a plan.
Then I'll send you an invoice for the follow-up formulation session and schedule the follow-up formulation call with you. During that call we can go over any further questions we may still have, review the goals, and discuss the plan. The phone calls typically take between 15–30 minutes.
In the next 1–3 business days after the call, I will create your new herb formula and then send you the invoice for the cost of the formula. Formulas are billed separately from the formulation session costs because each formula has different production costs depending on what herbs go into it. This also simplifies the process for future re-orders.
Once the herb formula payment is received, I will ship it out to you and will send you the tracking information.
You are welcome to use the customer portal to track the current progress of this process, as well as see your custom formulas and submit re-orders. Automatic payments and shipping will be an option once you are settled with a formula long term.
Additional Information
If I do not have an herb in stock that is needed for your formula, I will have to order it. That will likely add another 3–5 business days, but I will inform you if that is the case and give you the estimated arrival date of the herb once ordered.
Follow-up communication after the initial phone call will be via text or email (whichever you marked as preferred). I can answer any questions you may have, as well as make minor tweaks to the ratio of herbs in your formula for future batches.