ONLINE ORDER FORM
New Patient Sign Up
JADE LOTUS MEDICATION REQUEST FROM
Jade Lotus delivery currently covers these cities
Orange, Irvine, Tustin, Garden Grove, Stanton, Anaheim, Westminster, Huntington Beach
for all other cities please call to set up special arrangements.
HOW IT WORKS:
For quickest delivery place your order
Or you can call or text your order to our number
. If you plan on texting remember to text
full name, address, contact number, order and requested time and place for delivery
After orders are placed, a delivery driver will contact you to confirm your order and delivery instructions
For all other questions feel free to call.
Minimum donation per order is $75. There is an additional $7 delivery charge per order
Patient Full Name
Phone Number for confirmation
Address: (please fill all lines)
ORDER FORM: Please specify Strain(s), Quantity(s) and Time and Place for delivery.
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