RX Prescription Drug Authorization Form

Inovatiqa offers physicians prescription pharmaceutical. Please allow 2 to 5 days for your application to be processed.

In order to sell and ship prescription pharmaceuticals to you, we must receive authorization from the responsible physician at your place of business or service.

Please have the authorizing physician complete Prescription Drug Authorization Form and return it to us, along with a copy of his/her DEA registration or state license. We can only ship to within the state the physician is licensed in. If your facility does not have a Medical Director, but is licensed to purchase prescription products, please send us a copy of the license along with this letter for identification.