In order to sell and ship prescription pharmaceutical to you, we must receive authorization from the responsible physician at your place of business or service. Please have the authorizing physician complete this form and return it to us, along with a copy of his/her DEA registration or state license.

If your facility does not have a Medical Director, but is licensed to purchase prescription products, please send us a copy of the License along with this letter for identification.

Click the Next button to continue with the Prescription Authorization Process...