Cost-Plus Pharmacy. No Insurance Required.

Cart

“Buttercream Hydrating Lip Mask (15g)” has been added to your cart. Continue shopping

Remove item	Thumbnail image	Product	Price	Quantity	Subtotal
		DR JART Dermask Micro Jet Brightening Solution Sheet Mask	$7.00	DR JART Dermask Micro Jet Brightening Solution Sheet Mask quantity	$7.00
		Anti-Inflammatory Tea	$23.00	Anti-Inflammatory Tea quantity	$23.00
		Buttercream Hydrating Lip Mask (15g)	$19.00	Buttercream Hydrating Lip Mask (15g) quantity	$19.00
Coupon:

Cart totals

Subtotal	$49.00
Total	$49.00

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