Health Practitioner Authorization Form For Pharmaceutical Purchases
If you are a licensed medical provider, please use this form to be allowed to purchase prescription pharmaceuticals.
The provider must have a current active license with the authority to prescribe medications.
We will only sell to providers, we do not sell medications to end users or customers with prescription.
Sales are contingent upon state licensing restrictions and medication availability.
The provider must be the one to sign this form. We will verify the license through the appropriate authority.
This form allows us to ship medications to the facilities operating under the umbrella of the practitioner's license.
Medications will be shipped with a signature required and may or may not have additional shipping fees.
Healthcare Provider Authorization Form
