New Patient | North Shore Pharmacy | Shorewood - Cedarburg, WI

**As of June 5th 2024, we are OUT of covid vaccine, and will not be offering the updated version until after September 1st, check back for updates then**

New Patient

We would love the opportunity to serve as your trusted prescription provider.
Please fill out the form below and we will take it from here!

Pharmacy Location

First Name

Last Name

Address

City

State

Zip Code

Email Address

Phone Number

Birth Date (XX/XX/XXXX)

Alternate Contact Name

Alternate Contact Phone Number

Allergies

Optional Prescription Information

Auto Refill My Scripts

Send Text Notifications

Send Email Notifications

Previous Pharmacy Name

Previous Pharmacy Phone Number

Rx Number

Medication Name and Strength

Rx Number

Medication Name and Strength

Rx Number

Medication Name and Strength

Rx Number

Medication Name and Strength

Message to Pharmacist