Please complete this account form if you:
- Would like to start ordering compounds to administer in your office. All new prescriber’s must also complete the Prescriber’s Agreement.
- Have moved your practice location.
- Need to update practice information such as practice name, hours of operation, contact emails, or a change in staff.
- Update billing information.
Please complete this Prescriber’s Agreement if you:
- Are a new prescriber and are wanting to administer a compounded product in your office.
- Would like access to the Prescriber’s Portal.
- Would like to designate agents to electronically submit prescriptions through the Prescriber’s Portal on your behalf.