How to verify your professional status without a DEA number

If you are a prescribing U.S. or Canadian medical practitioner and do not have a personal DEA number, please complete the following form and click Submit. You’ll hear back from us via email (within 1 to 2 business days) with further instructions.
* Indicates required information
*First Name
Legal given name, as on passport
*Last Name
Legal surname, as on passport; do not include degree or title
*Street Address
*State or Province
*Zip or Postal Code
*Email Address
Enter the email address where we should respond to you
*Medical Degree
What best describes your medical degree?
License Number
License number (or equivalent)
*Prescription Authorization
Are you authorized to write prescriptions?
Additional Comments
Enter any additional comments that would help us to verify your professional credentials