1. Determine the medications you would like to dispense based on the medications most prescribed in your office. Please provide us with the medication name, strength, and size on the Medication Price Request Form (click to download) or provide us with your established formulary.

  2. Please fill out our Practice Information Form (click to download). This short form provides us with important information about your practice so we can suggest the best programs and services to complement your practice specialty and patient demographics.

  3. Please fill out our New Account Packet (click to download) per Federal DEA requirements.

  4. Complete the Business Credit Application.

  5. If paying for your medications via a method other than Check: 
    • If paying by CREDIT CARD – Credit & Debit Card Authorization Form
    • If paying by CHECK-BY-FAX – Check by Fax Form
    • If paying by ACH – ACH Payment Form


Fax all documents to: 1-800-563-6967 - OR - eMail to:


Upon receipt of all completed documentation, an Aidarex Representative will contact you within 24 hours to walk you through the next steps to establish your account and ship your first order.