One Time Registration

Contact Information

First Name* Middle Name Last Name*

Email* Confirm Your Email*

Password* Confirm Your Password*

Street Address*

City* Apt/Suite No

Country*

State/Province* Zip Code/Postal Code*

Phone*

How did you hear about us? *

* Indicates required field

Registering an account is completely free and helps you avoid re-entering your information every time you order from YouDrugstore. We keep your information private and secure.

Toll free: 1-855-968-6337
Monday: 9:00AM - 6:30PM EST
Tuesday - Friday: 9:00AM - 8:00PM EST
Saturday: 9:00AM - 6:00PM EST
Sunday: Closed

* Indicates required field

Please fill in the appropriate information where applicable. Fields that do not apply to you should be left blank..

Medical Information

Gender*

Male Female

Date of Birth*

Height* Weight*

Current Medical Conditions - Please list your current medical condition(s)* Drug Allergies - Please list all your allergies and include any necessary comments* Current Medication - Please list all medications/supplements you currently take*

All of our medications are shipped in child-protective packaging. Would you like us to include an additional vial with non-safety caps for easy opening?*

Yes No

Our dispensing pharmacy offers medication counseling to all of its patients. Would you like to receive counseling on your medication?*

Yes No

Your Doctor's Information

First Name* Last name*

Phone Number* Clinic Name Clinic Address

City Apt/Suite No

Country

State/Province Zip Code/Postal Code

Final Step

BY CLICKING REGISTER, I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS SET OUT IN THE AGREEMENT (INCLUDING SCHEDULE "A") AS FOUND HERE

AND I AGREE, ON BEHALF OF MYSELF, MY HEIRS, SUCCESSORS, ADMINISTRATORS AND ASSIGNS, TO BE BOUND BY THESE TERMS AND CONDITIONS.