Practitioner Resources

Our forms are in Microsoft Word.
Please fill them out and email back to us.


KW Formulation Service Form
Please email a detailed and concise health history for your patient. Brian Kie Weissbuch L.Ac. will formulate and create an herbal fluid extract based upon the case history you provide.
download the form

Practitioner Prescription Form

Please type your unique patient Rx & email it to us as a MS Word document.  pdf’s, handwritten, and other formats cannot be entered into our database! We will create your herbal formula as a fluid extract and ship this to you or to your patient via UPS.
download the form

You can either keep a blank copy of the forms on your computer
and save a copy for each new patient and/or prescription order,
OR you can always return to this page for new empty forms.

Please email completed form to:

Kw Single Herb Fluid Extracts, Latin Index
open the pdf here to download

Kw Single Herb Fluid Extracts, Pin Yin Index
open the pdf here to download

Kw Traditional Chinese Medical Formulas Pin Yin
open the pdf here to download

You will need acrobat reader or preview on a mac to view the pdfs