Prescription window for females of reproductive potential is 7 days beginning with the date of the pregnancy test specimen collection. Prescription window for females of non-reproductive potential and males is 30 days beginning with date of the office visit.

Prescriber Registration

Attention: This registration page is for licensed prescribers only. If you are a patient, you must be registered in iPLEDGE by your doctor.

Please provide your DEA number. This will be used as your Username to identify you in the program and for you to login to the iPLEDGE system using the phone or internet site. The DEA number provided must be your DEA number, not an institutional or shared DEA number. Please provide only one DEA number if you have more than one.

If you do not have a DEA number, check the box indicating that you would like the program to generate a Username to be used to identify you in the program. This program generated Username will be shipped to you in your prescriber educational kit.

DEA Number   or   

Enter or confirm your information


* denotes required field
First Name*   Last Name*   MI Suffix

Specialty

Address*
City* State* Zip*
Phone*  Fax
Email 
Preferred Method of Communication*  
 

Select delegates

DEA Number or Username
 
Delegate List
Expiration Date (MM/DD/YYYY)


Click the Save and Print button below. This will present a print friendly registration form for your signature. After printing and signing, return the form to the address or fax number found on the form.