Herbal Solidarity Request Form

Please complete the form below to request herbal support from the Solidarity Apothecary. Please put n/a in the boxes not relevant to you. Thanks! Click here to learn more about the apothecary.

Name

Pronouns

Location

About you - Individuals and Families e.g. Family member is in prison, recently arrested, on trial etc.

About you - Groups, Projects, Collectives. About your project with a brief description of what you do etc e.g. We support people leaving prison, we are living at a protest site, we are a refugee solidarity group etc.

Number of people

What herbal support do you need right now? For example immunity support, stress support etc. Don’t worry if you don’t know about the herbs, just share a bit about your general health needs right now.

Are you or anyone in your group pregnant?

Are you or anyone in your group on any existing medication? Please list if possible due to herbal safety, contraindication risks etc.

Are there any urgent dates that I should be aware e.g. court case dates

Postal address(es) for sending medicines

Any other comments