For qualified healthcare organizations

Register your practice

Tell us about your organization. Our team will verify your credentials and follow up with next steps.

Tell us about your practice
Organization and contact details only — the form takes a few minutes and never asks for patient information.
We verify credentials
Our team verifies provider credentials and licensure before any account is activated.
You onboard and order
We set up your account and walk your staff through ordering, including e-prescribing.

Direct contact

customersupport@trupharmarx.com

(888) 364-6609

Please note: this form is for practice enrollment only. Do not submit patient names, prescriptions, diagnoses, medical records, or any other patient-specific or protected health information (PHI).

Fields marked are required.

Primary contact

First name

Last name

Phone

Your role

e.g. Physician, practice manager, owner

Practice profile

Practice or company name

Practice website

Optional

Street address

Suite / unit

Optional

City

State

ZIP code

Operational snapshot

Which best describes your organization

Areas of interest & notes

Treatment areas or medications of interest

Optional. Do not include patient-specific information.

Additional information

Optional

Final details

How did you hear about us?

I understand this form is for practice enrollment only, and I will not submit patient-specific information or protected health information (PHI) through this form.

Register your practice

Tell us about your practice

We verify credentials

You onboard and order