Get Texas Dps Form 77 78

Filling out the Texas Dps Form 77 78 can be straightforward when you follow the right steps. This guide will walk you through each section of the form and provide clear instructions to ensure that you complete it accurately and efficiently.

Follow the steps to complete your Texas Dps Form 77 78 online

1. Click 'Get Form' button to access the document and open it in an editor.
2. Begin by selecting whether you are applying for a new registration or an additional registration. If your application is for a new registration due to a change in ownership or name, be sure to provide the old name and DPS number in the space provided.
3. In the applicant information section, enter your last name, first name, middle name, and suffix (if applicable). Include your degree, business name, social security number, email address, date of birth, current board license number, and its expiration date.
4. Fill in the current federal (DEA) registration number and its expiration date if you have one. Include your current national provider identifier (NPI) if applicable.
5. Provide your business address, ensuring to include the physical address required (P.O. Box is not acceptable). Fill in the city, state, phone number type (office, cell, or home), ZIP code, and county. If applicable, you may include your international phone number.
6. In the business activity section, select only one activity that applies to you and specify the type of practitioner in the provided space.
7. Indicate which drug schedules you intend to handle. You may select all relevant schedules that apply to your registration.
8. Answer the liability questions regarding your authorization and any past convictions by selecting yes or no for each question. If you answer yes to certain questions, you may need to attach a letter explaining the circumstances.
9. Verify that the information provided is correct and complete. Understand that this is an official government record and that any false information may result in criminal prosecution.
10. Sign the application, noting the requirement that only specific individuals may sign based on the type of application (for example, hospital administrator or pharmacist-in-charge).
11. Once completed, you can save your changes, download the form, print it, or share it as required.

Complete your Texas Dps Form 77 78 online today to ensure your registration is processed efficiently.