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FORMS

School Entry Health Exam Form School Entry Health Exam Form
School Entry Health Exam Form
$15.00

DH3040 (formally known as the “yellow form”)

Please note that all products are available for pick-up only.

Athletic Physical Form Athletic Physical Form
Athletic Physical Form
$15.00

MDCPS Athletic Physical Form (FM3439)

CETAPHIL MOISTURIZING CREAM 3OZ CETAPHIL MOISTURIZING CREAM 3OZ
CETAPHIL MOISTURIZING CREAM 3OZ
$6.50

3 oz

DIFFERIN 0.1% ADAPALENE GEL 45GM DIFFERIN 0.1% ADAPALENE GEL 45GM
DIFFERIN 0.1% ADAPALENE GEL 45GM
$34.00

pump

Ear Piercing Ear Piercing
Ear Piercing
$105.00

On-site products

CETAPHIL RESTORADERM SOOTHING WASH CETAPHIL RESTORADERM SOOTHING WASH
CETAPHIL RESTORADERM SOOTHING WASH
$21.00

10 oz

CETAPHIL DAILY FACIAL MOISTRZ CETAPHIL DAILY FACIAL MOISTRZ
CETAPHIL DAILY FACIAL MOISTRZ
$20.75

4 oz SPF 15

School Immunization Form School Immunization Form
School Immunization Form
$15.00

DH680 (formally known as the “blue form”)

DIFFERIN ACNE PRONE SKIN PATCHES DIFFERIN ACNE PRONE SKIN PATCHES
DIFFERIN ACNE PRONE SKIN PATCHES
$11.25

36 pads

CETAPHIL HYDRATING FOAMING CLEANSER CETAPHIL HYDRATING FOAMING CLEANSER
CETAPHIL HYDRATING FOAMING CLEANSER
$12.00

8 oz

DIFFERIN DAILY DEEP CLEANSER 5% DIFFERIN DAILY DEEP CLEANSER 5%
DIFFERIN DAILY DEEP CLEANSER 5%
$11.75

BPO 4 oz

On-site SERVICES