🌿 Re-Fill or Existing Customer Form

I'm one of Jacinta's existing customers (but have not purchased from JingWell Before)

I already have a formula from a TCM practitioner

Have you ordered from us before?

I confirm that this is a formula provided to me by a qualified TCM practitioner, and that I understand JingWell may not proceed with a refill order if the formula is incomplete or cannot be verified.

Going well – I’d like to continue with the same formula

Setback – Symptoms have gotten worse or new ones have come up

Refocus – I’d like to address a specific aspect of my condition or something new that’s come up.

What best describes your current condition?

Are there any new symptoms you’d like us to address?

Terms and Conditions

I understand that this is a personalised herbal formula created based on the information I’ve provided, and I consent to proceeding with its preparation and delivery.

I agree to the terms & conditions and Privacy Policy

🌿 Re-Fill or Existing Customer Form

Full Name

Email Address

Have you ordered from JingWell before?