Medicine Order Form

Medicine Order Form

Having an illness and wanting to order your medicine online? Use our form template to request your preferred pharmacy for delivery! Form Preview
Order Your Medicines Here
  • Order Your Medicines Here

  • Name Price Quantity
    Punarnava Ark (500 ml) 180.00 INR
    Arjun Ark (500 ml) 180.00 INR
    Kanchanar Ark (500 ml) 180.00 INR
    Raktashuddhi Ark (500 ml) 230.00 INR
    Chobchini Ark (500 ml) 230.00 INR
    Gudmaradi Ark (500 ml) 320.00 INR
    Tulsi Ark (500 ml) 180.00 INR
    Parijat Ark (500 ml) 180.00 INR
    Saptarangi Ark (500 ml) 180.00 INR
    Giloy Ark (500ml) 180.00 INR
    Sarpgandha Ark (500 ml) 180.00 INR
    Nari Sanjivani (500 ml) 180.00 INR
    Baal Pal Ras (200 ml) 100.00 INR
    Manjishtha Ark (500ml) 180.00 INR
    Pashanbhed Ark (500 ml) 180.00 INR
    Nandi Ark (500 ml) 180.00 INR
    Normal Gomutra Ark(500 ml) 100.00 INR
    Alovera Ark(500 ml) 300.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Triphala Ghanavati (120 pills) 80.00 INR
    Tulasi Ghanavati(120 tabs) 100.00 INR
    Bhasm Ghanavati(12 tabs) 100.00 INR
    Punarnava Ghanavati(120 tabs) 100.00 INR
    Sarpgandha Ghanavati(120 tabs) 100.00 INR
    Haldi Ghanavati(120 tabs) 100.00 INR
    Panchgavya Ghanavati(120 tabs) 100.00 INR
    Haritaki Vati(120 tabs) 100.00 INR
    Madhuvati(120 tabs) 100.00 INR
    Manjishta Ghanavati(120 tabs) 100.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Ayur Ghee Plus (10 ml) 60.00 INR
    Netranjan(10 ml) 150.00 INR
    Karna Bindu(10 ml) 150.00 INR
    Amrit Dhara(10 ml) 150.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Pachanamrit (60 gm) 60.00 INR
    Madhuveri Churna (100 gm) 75.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Takrasav (500 ml) 150.00 INR
    Gaumutra Asav(500 ml) 270.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Panchgavya Ghrit (250 ml) 750.00 INR
    Real Ghee (500 gm) 799.00 INR
    Liv Detox Oil(250 ml) 400.00 INR
    Maraham External Ointemnt(15 gm) 25.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Cow Collestrum(50 gm) 1,365.00 INR
    Aloevera Gel(500 ml) 110.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Gopika Haircleanser (100 ml) 50.00 INR
    Kesh Nikhar (100 ml) 50.00 INR
    Panchagavya Lotion (100 ml) 60.00 INR
    Tejasvini (100 gm) 65.00 INR
    Bramhi Amla (100 ml) 90.00 INR
    Dantamanjana (50 gm) 30.00 INR
    Angamardanam Tailam (60 ml) 70.00 INR
    Angarakshak Soap (75 gm) 25.00 INR
    Gau Amrit Soap 50.00 INR
    Go Real Soap 20.00 INR
    Gopika (75 gm) 35.00 INR
    Ubtan Powder (100 gm) 30.00 INR

    Item subtotal: 0.00 INR

    Name Price Quantity
    Havan Samagri (200 gm) 35.00 INR
    Dhoop 30.00 INR

    Item subtotal: 0.00 INR




    Subtotal:   0.00 INR Tax:   0.00 INR Shipping:   0.00 INR Total:   0.00 INR
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