The Application for Registration/Renewal and Certificate of Exemption From Fee forms (if applicable) must be submitted together by mail. Please note that the Application for Registration form may be submitted for both new applications and renewals. If submitting a renewal, please mark the form appropriately as a renewal and include the current CSR number. A $25 registration fee will be required for the initial issuance of the registration and for each subsequent renewal. Payment can be made with either money order or check made payable to TX DPS. If the renewal is received after the expiration date, an additional $50 late fee will be due at the time of application. Renewals will be accepted no more than 90 days prior to expiration. If a renewal is received too early it will be returned.
Prior to registration or renewal your supervising/delegating physician must be listed with the Texas Medical Board as giving you prescriptive authority for controlled substances. The information must reflect an approval date and “yes” must be indicated for controlled substances as well as delegating prescriptive authority.
EMS may use the Application for Registration/Renewal for Practitioners with additional information. Signature of the EMS administrator, as listed with Texas DSHS, may sign in the space for “Signature of Applicant.” The Medical Director’s signature, CSR number and Board license number are required. This can be added at the bottom of the form.
The Modification of Registration - EMS form may be used to include the current information for the DSHS listed Administrator and Medical Director as recorded on the DSHS website.
Pharmacies will use the same application as practitioners. The fields for name, DOB and SSN may be left blank. Indicate the name of the Pharmacy in the address information area.
The Modification of Registration and Report of Theft, Loss, or Surrender of Controlled Substances forms listed below must be signed by the registrant. The completed form may be scanned and e-mailed to RSD_Customer_Relations@txdps.state.tx.us or faxed to (512) 424-5799.
Precursor Chemical/Laboratory Apparatus Forms: There are several forms available on the DPS website regarding the Precursor Chemical Statute, including:
Texas Prescription Program Forms: There are several forms available on the DPS website regarding the Texas Prescription Program, including:
Multi-County Drug Task Force Application (NAR-122)
This form is for use by law enforcement agencies seeking to create a new multi-county drug task force.