Email address (required) MUSHROOM SUPPLEMENTS via Jing Tang Please choose one if applicable NUTRIHERB SUPPLEMENTS via Jing Tang (combination of Western Neutraceuticals & Chinese Herbs) Please choose one if applicable Additional Nutriherb Requests if applicable JING TANG HERBAL REFILL ONE Name of Pet-Patient Name of Herbal refill request : Bao He Wan Body Sore Body Sore for Pregnant Mom Bone Healing Bone Stasis Breathe Easier B Bu Xie Xi Feng (nourish blood/clear internal wind) Bu Zhong Yi Qi Tang (tonify Qi & raise sunken yang ie fecal incontinence) Cervical Formula Coptis Powder (lick granuloma/wounds) Crystal Stone Formula Di Gu Pi (bony bi/arthritis) Damp Heat Skin Di Tan Tang (seizures) Double P Ear Damp Heat Eight Gentelman (Spleen Qi/GI) Eight Righteous Eight Treasures External Wind (allergies) Four Paws Damp Heat Gui Pi Tang Great Saussurea (bloody diarrhea) Haliotis Formula (ocular diseases) Happy Earth Heart Qi Tonic Hindquarter Weakness Hot Hoof II Hot Hoof I Hueys Formula Huo Xiang Zheng Qi (releases exterior, drains damp, regulates qi, harmonized middle jaio i.e. GI Jiang Tang Cha Jin Suo Gu Jing (urinary incontince) Jing Gui Shen Qi Lilly Combination Liver Happy Max Formula Nasal Damp Heat New Xiang Ru San Ophiopogon Powder Red Back Door Red Front Door Rehmannia 6 Rehmannia 11 Rehmannia 14 Stasis Breaker Stomach Happy Shen Calmer Shen Ling Bai Zhu (tonify qi, strengthen spleen, eliminate damp i.e. diarrhea Stasis in Mansion of Mind Tendon Ligament Wei Qi Booster Yin Xi San (nasal tumors) Strength of blend requested above : Teapills (cats/small dogs) Concentrated Tincture (liquid for cats/small dogs) Concentrated Capsule 0.2g x 50 (cats/small dogs under 10lbs) Concentrated Capsule 0.5g x 100 (medium/large dogs)-MOST COMMON Powder 200g (cinnamon like consistency) Powder 600g (cinnamon like consistency) Concentrated Powder Granules 90g Regular Size Bottle (large dogs/horses)-MOST COMMON Concentrated Powder Granules 180g Large Size Bottle (large dogs/horses) Topical for Skin Topical Ear Drop Topical Eye Drop Please use this space to provide additional patient dosing updates or questions for Dr. Brown JING TANG HERBAL REFILL TWO Name of Pet-Patient Name of Herbal refill request : Bao He Wan Body Sore Body Sore for Pregnant Mom Bone Healing Bone Stasis Breathe Easier B Bu Xie Xi Feng (nourish blood/clear internal wind) Bu Zhong Yi Qi Tang (tonify Qi & raise sunken yang ie fecal incontinence) Cervical Formula Coptis Powder (lick granuloma/wounds) Crystal Stone Formula Di Gu Pi (bony bi/arthritis) Damp Heat Skin Di Tan Tang (seizures) Double P Ear Damp Heat Eight Gentelman (Spleen Qi/GI) Eight Righteous Eight Treasures External Wind (allergies) Four Paws Damp Heat Gui Pi Tang Great Saussurea (bloody diarrhea) Haliotis Formula (ocular diseases) Happy Earth Heart Qi Tonic Hindquarter Weakness Hot Hoof II Hot Hoof I Hueys Formula Huo Xiang Zheng Qi (releases exterior, drains damp, regulates qi, harmonized middle jaio i.e. GI Jin Suo Gi Jing (urinary incontince) Jiang Tang Cha Jing Gui Shen Qi Lilly Combination Liver Happy Max Formula Nasal Damp Heat New Xiang Ru San Ophiopogon Powder Red Back Door Red Front Door Rehmannia 6 Rehmannia 11 Rehmannia 14 Stasis Breaker Stomach Happy Shen Calmer Shen Ling Bai Zhu (tonify qi, strengthen spleen, eliminate damp i.e. diarrhea Stasis in Mansion of Mind Tendon Ligament Wei Qi Booster Yin Xi San (nasal tumors) Strength of blend requested above : Teapills (cats/small dogs) Concentrated Tincture (liquid for cats/small dogs) Concentrated Capsule 0.2g x 50 (cats/small dogs under 10lbs) Concentrated Capsule 0.5g x 100 (medium/large dogs)-MOST COMMON Powder 200g (cinnamon like consistency) Powder 600g (cinnamon like consistency) Concentrated Powder Granules 90g Regular Size Bottle (large dogs/horses)-MOST COMMON Concentrated Powder Granules 180g Large Size Bottle (large dogs/horses) Topical for Skin Topical Ear Drop Topical Eye Drop JING TANG HERBAL REFILL THREE Name of Pet-Patient Name of herbal refill request : Bao He Wan Body Sore Body Sore for Pregnant Mom Bone Healing Bone Stasis Breathe Easier B Bu Xie Xi Feng (nourish blood/clear internal wind) Bu Zhong Yi Qi Tang (tonify Qi & raise sunken yang ie fecal incontinence) Cervical Formula Coptis Powder (lick granuloma/wounds) Crystal Stone Formula Di Gu Pi (bony bi/arthritis) Damp Heat Skin Di Tan Tang (seizures) Double P Ear Damp Heat Eight Gentelman (Spleen Qi/GI) Eight Righteous Eight Treasures External Wind (allergies) Four Paws Damp Heat Gui Pi Tang Great Saussurea (bloody diarrhea) Haliotis Formula (ocular diseases) Happy Earth Heart Qi Tonic Hindquarter Weakness Hot Hoof II Hot Hoof I Hueys Formula Huo Xiang Zheng Qi (releases exterior, drains damp, regulates qi, harmonized middle jaio i.e. GI Jin Suo Gu Jing (urinary incontinence Jiang Tang Cha Jing Gui Shen Qi Lilly Combination Liver Happy Max Formula Nasal Damp Heat New Xiang Ru San Ophiopogon Powder Red Back Door Red Front Door Rehmannia 6 Rehmannia 11 Rehmannia 14 Stasis Breaker Stomach Happy Shen Calmer Shen Ling Bai Zhu (tonify qi, strengthen spleen, eliminate damp i.e. diarrhea Stasis in Mansion of Mind Tendon Ligament Wei Qi Booster Yin Xi San (nasal tumors) Strenght of herbal requested above : Teapills (cats/small dogs) Concentrated Tincture (liquid for cats/small dogs) Concentrated Capsule 0.2g x 100 (cats/small dogs under 10lbs) Concentrated Capsule 0.5g x 100 (medium/large dogs)-MOST COMMON Powder 200g (cinnamon like consistency) Powder 600g (cinnamon like consistency) Concentrated Powder Granules 90g Regular Size Bottle (large dogs/horses)-MOST COMMON Concentrated Powder Granules 180g Large Size Bottle (large dogs/horses) Topical for Skin Topical Ear Drop Topical Eye Drop JING TANG HERBAL REFILL FOUR Name of Pet Patient Name of herbal refill request : Bao He Wan Body Sore Body Sore for Pregnant Mom Bone Healing Bone Stasis Breathe Easier B Bu Xie Xi Feng (nourish blood/clear internal wind) Bu Zhong Yi Qi Tang (tonify Qi & raise sunken yang ie fecal incontinence) Cervical Formula Coptis Powder (lick granuloma/wounds) Crystal Stone Formula Di Gu Pi (bony bi/arthritis) Damp Heat Skin Di Tan Tang (seizures) Double P Ear Damp Heat Eight Gentelman (Spleen Qi/GI) Eight Righteous Eight Treasures External Wind (allergies) Four Paws Damp Heat Gui Pi Tang Great Saussurea (bloody diarrhea) Haliotis Formula (ocular diseases) Happy Earth Heart Qi Tonic Hindquarter Weakness Hot Hoof II Hot Hoof I Hueys Formula Huo Xiang Zheng Qi (releases exterior, drains damp, regulates qi, harmonized middle jaio i.e. GI Jin Suo Gu Jing (urinary incontinence) Jiang Tang Cha Jing Gui Shen Qi Lilly Combination Liver Happy Max Formula Nasal Damp Heat New Xiang Ru San Ophiopogon Powder Red Back Door Red Front Door Rehmannia 6 Rehmannia 11 Rehmannia 14 Stasis Breaker Stomach Happy Shen Calmer Shen Ling Bai Zhu (tonify qi, strengthen spleen, eliminate damp i.e. diarrhea Stasis in Mansion of Mind Tendon Ligament Wei Qi Booster Yin Xi San (nasal tumors) Strength of blend requested above : Teapills (cats/small dogs) Concentrated Tincture (liquid for cats/small dogs) Concentrated Capsule 0.2g x 50(cats/small dogs under 10lbs) Concentrated Capsule 0.5g x 100 (medium/large dogs)-MOST COMMON Powder 200g (cinnamon like consistency) Powder 600g (cinnamon like consistency) Concentrated Powder Granules 90g Regular Size Bottle (large dogs/horses)-MOST COMMON Concentrated Powder Granules 180g Large Size Bottle (large dogs/horses) Topical for Skin Topical Ear Drop Topical Eye Drop JING TANG HERBAL REFILL FIVE Name of Pet Patient Name of herbal refill request : Bao He Wan Body Sore Body Sore for Pregnant Mom Bone Healing Bone Stasis Breathe Easier B Bu Xie Xi Feng (nourish blood/clear internal wind) Bu Zhong Yi Qi Tang (tonify Qi & raise sunken yang ie fecal incontinence) Cervical Formula Coptis Powder (lick granuloma/wounds) Crystal Stone Formula Di Gu Pi (bony bi/arthritis) Damp Heat Skin Di Tan Tang (seizures) Double P Ear Damp Heat Eight Gentelman (Spleen Qi/GI) Eight Righteous Eight Treasures External Wind (allergies) Four Paws Damp Heat Gui Pi Tang Great Saussurea (bloody diarrhea) Haliotis Formula (ocular diseases) Happy Earth Heart Qi Tonic Hindquarter Weakness Hot Hoof II Hot Hoof I Hueys Formula Huo Xiang Zheng Qi (releases exterior, drains damp, regulates qi, harmonized middle jaio i.e. GI Jin Suo Gu Jing (urinary incontinence) Jiang Tang Cha Jing Gui Shen Qi Lilly Combination Liver Happy Max Formula Nasal Damp Heat New Xiang Ru San Ophiopogon Powder Red Back Door Red Front Door Rehmannia 6 Rehmannia 11 Rehmannia 14 Stasis Breaker Stomach Happy Shen Calmer Shen Ling Bai Zhu (tonify qi, strengthen spleen, eliminate damp i.e. diarrhea Stasis in Mansion of Mind Tendon Ligament Wei Qi Booster Yin Xi San (nasal tumors) Strength of herbal requested above : Teapills (cats/small dogs) Concentrated Tincture (liquid for cats/small dogs) Concentrated Capsule 0.2g x 50 (cats/small dogs under 10lbs) Concentrated Capsule 0.5g x 100 (medium/large dogs)-MOST COMMON Powder 200g (cinnamon like consistency) Powder 600g (cinnamon like consistency) Concentrated Powder Granules 90g Regular Size Bottle (large dogs/horses)-MOST COMMON Concentrated Powder Granules 180g Large Size Bottle (large dogs/horses) Topical for Skin Topical Ear Drop Topical Eye Drop JING TANG HERBAL REFILL SIX Name of Pet Patient Name of herbal refill request : Bao He Wan Body Sore Body Sore for Pregnant Mom Bone Healing Bone Stasis Breathe Easier B Bu Xie Xi Feng (nourish blood/clear internal wind) Bu Zhong Yi Qi Tang (tonify Qi & raise sunken yang ie fecal incontinence) Cervical Formula Coptis Powder (lick granuloma/wounds) Crystal Stone Formula Di Gu Pi (bony bi/arthritis) Damp Heat Skin Di Tan Tang (seizures) Double P Ear Damp Heat Eight Gentelman (Spleen Qi/GI) Eight Righteous Eight Treasures External Wind (allergies) Four Paws Damp Heat Gui Pi Tang Great Saussurea (bloody diarrhea) Haliotis Formula (ocular diseases) Happy Earth Heart Qi Tonic Hindquarter Weakness Hot Hoof II Hot Hoof I Hueys Formula Huo Xiang Zheng Qi (releases exterior, drains damp, regulates qi, harmonized middle jaio i.e. GI Jin Suo Gu Jing (urinary incontinence) Jiang Tang Cha Jing Gui Shen Qi Lilly Combination Liver Happy Max Formula Nasal Damp Heat New Xiang Ru San Ophiopogon Powder Red Back Door Red Front Door Rehmannia 6 Rehmannia 11 Rehmannia 14 Stasis Breaker Stomach Happy Shen Calmer Shen Ling Bai Zhu (tonify qi, strengthen spleen, eliminate damp i.e. diarrhea Stasis in Mansion of Mind Tendon Ligament Wei Qi Booster Yin Xi San (nasal tumors) Strength of herbal requested above : Teapills (cats/small dogs) Concentrated Tincture (liquid for cats/small dogs) Concentrated Capsule 0.2g x 50(cats/small dogs under 10lbs) Concentrated Capsule 0.5g x 100 (medium/large dogs)-MOST COMMON Powder 200g (cinnamon like consistency) Powder 600g (cinnamon like consistency) Concentrated Powder Granules 90g Regular Size Bottle (large dogs/horses)-MOST COMMON Concentrated Powder Granules 180g Large Size Bottle (large dogs/horses) Topical for Skin Topical Ear Drop Topical Eye Drop Please list current dosing being given to patient (s) or questions for Dr. Brown. 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