Si Jin Bao

Relief

Professionals

Prescription Form

Herbacy Prescription Submission

Herbacy Prescription Submission

Practitioner Information

Practitioner must have an active Professional Account with Si Jin Bao PRO (https://www.professionals.sijinbao.com/)
Name
Name
First
Last
Practice Address
Practice Address
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Country

Patient Information

Please note, you will need 1 form per PATIENT/CLIENT.
Patient Name
Patient Name
First
Last

Herbacy Prescription Eastern Physician

Prescriptions are valid for up to 90 days unless otherwise indicated.
All Professional internal decoctions are 1oz and last for eleven and a half (11 1/2) days for an adult dosage. Please refer to your SJB PRO account for more information.
If suggesting Off Label Use, please include that in the Special Instructions.
Please include the requested size (2oz or 4oz) if you have prescribed PRO Revive, Schmoove or Wonderful as well as any special dosage instructions.
plus1 Add Formula minus1 Remove Formula

Herbacy Prescription Western Physician

Prescriptions are valid for up to 90 days unless otherwise indicated.
All Professional internal decoctions are 1oz and last for eleven and a half (11 1/2) days for an adult dosage. Please refer to your SJB PRO account for more information.
Please include the requested size (2oz or 4oz) if you have prescribed PRO Revive, Schmoove or Wonderful as well as any special dosage instructions.
plus1 Add Formula minus1 Remove Formula

Herbacy Prescription Esthetician

Prescriptions are valid for up to 90 days unless otherwise indicated.
All Professional internal decoctions are 1oz and last for eleven and a half (11 1/2) days for an adult dosage. Please refer to your SJB PRO account for more information.
Please include the requested size (2oz or 4oz) if you have prescribed Revive, Schmoove or Wonderful or any special Dosage instructions.
plus1 Add Formula minus1 Remove Formula

Terms & Conditions

Please be advised that ancient healing systems such as traditional Chinese Medicine, Classical Chinese Medicine , Ancient Chinese Medicine, Kampo ( Traditional Japanese Herbal Medicine), or Hangul ( Traditional Korean Medicine) are vastly different in the diagnosis and treatment of dysfunctional physiological processes namely diseases. The appropriate trained professional should be consulted on any specified condition. Any alteration to standard dosage recommendations made by the licensed professional will be at their sole discretion and assumes all liability. All licensed professionals hold the manufacturer harmless of all prescribed herbaceuticals offered.