ACCOUNT FORM

SIGN ACCOUNT FORM

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.

PRESCRIBER'S AGREEMENT

SIGN PRESCRIBER'S AGREEMENT

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.