Cost-Plus Pharmacy. No Insurance Required.

Cart

“Whitening Strips 14pk” has been added to your cart. Continue shopping

Remove item	Thumbnail image	Product	Price	Quantity	Subtotal
		Vegan Hyaluronic Acid in Aloe Vera Facial Serum	$18.00	Vegan Hyaluronic Acid in Aloe Vera Facial Serum quantity	$18.00
		Nourish Lavender + MCT Cleansing Oil (60mL)	$17.00	Nourish Lavender + MCT Cleansing Oil (60mL) quantity	$17.00
		Whitening Strips 14pk	$37.99	Whitening Strips 14pk quantity	$37.99
Coupon:

Cart totals

Subtotal	$72.99
Total	$72.99

Proceed to checkout

New Patient Registration

FIrst Name

Last Name

Date of Birth

Gender

Height (inches)

Weight (lbs)

Email

Your Phone

Preferred Method of Contact

Address

Are you filling a medication for your pet?

Pet name*

Date of birth:

Species type:

Allergies: (enter n/a if not applicable) - include name of patient

Taking any medications, currently?

Yes - for me No - for me Yes - for pet No - for pet

If yes, Please list all medications here (include name of patient)

Prescriptions:

Please select all that apply:

Previous/Current Pharmacy Contact Information

In case of emergency:

First Name

Last Name

Relationship

Contact Number