Request for More Info - Healthcare Providers

Quick Start Toolkit
Options start at just $99

First Time Customers

• Verification Form
• Application for Credit

*Note: You will need to provide a copy of your DEA Registration and State Licensure Materials

Returning Customers

• Credit Card Authorization Form
• Inventory - Schedule I-II - Request for DEA Form 222
• Inventory - Schedule III-V
• Inventory - Non-Scheduled
• Inventory - Compound - Non-Scheduled
• Inventory - Compound - CIII-V
  

Fax items to 480-659-2353