Get Practitioner’s Controlled Substance Registration Application

Completing the Practitioner’s Controlled Substance Registration Application online can be a straightforward process with the right guidance. This guide will provide you with step-by-step instructions to ensure all necessary information is accurately submitted.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your applicant name in the designated section. Ensure that you fill this in using clear and legible text.
3. Enter your date of birth in the appropriate field. This is crucial for verifying your identity as part of the registration.
4. Input your Social Security number. This information is necessary for processing your application.
5. Specify your gender by selecting the appropriate checkbox. Use inclusive terms, such as ‘they’ if applicable.
6. Fill in your home address, noting that this is required for your registration.
7. Add your mailing address if it differs from your home address. Providing a reliable mailing address ensures you receive communications regarding your application.
8. Enter your work address, including the city, state, and zip code.
9. Provide your home telephone number, cellphone number, and work telephone number, ensuring that you can be reached easily.
10. Input your email address. This will facilitate electronic communication regarding your application.
11. Select the schedules of drugs for which you are applying by checking all applicable boxes.
12. Indicate your New Mexico professional board by selecting the appropriate checkbox. If your board is not listed, write it in the space provided.
13. Enter your New Mexico professional license number and the current expiration date.
14. Prepare to attach a copy of your professional license, as this is mandatory for the issuance of your controlled substance license.
15. Carefully read the statements regarding criminal history and disciplinary actions. Sign each statement where indicated to confirm your compliance.
16. If applicable, provide explanations for any failure to meet the statements' requirements, including relevant documentation.
17. Finally, certify that the information provided in your application is accurate and true to the best of your knowledge by signing and dating the application.
18. Once you have filled out the form, you can save changes, download, print, or share the completed application as needed.

Take the next step towards ensuring your compliance by completing your documents online.