Rx Authorization - DermaClip

Rx Authorization

DermaClip is an Rx-only medical device. Federal law requires authorization from a licensed practitioner before your first order can be processed.

The process is simple — complete and sign the authorization form online, send a copy of your current practitioner license to rxform@dermaclip.com, and our team will verify eligibility. Most authorizations are reviewed within one business day.

Who Can Authorize

  • Physician

  • Medical Director

  • Pharmacist-in-Charge

  • Physician Assistant (PA)

  • Nurse Practitioner (NP)

What You'll Need

  • Facility Information

    Company name · Street address · City, state & ZIP · Phone & mobile numbers · Email address

  • Practitioner Information

    First & last name · License number, issuing state & expiration date · NPI number · Direct phone & email · Current license copy (email to rxform@dermaclip.com)

What Happens Next

1. Submit your authorization — Complete and sign the form online via Adobe Acrobat Sign. Email a copy of your current practitioner license to rxform@dermaclip.com.

2. We verify eligibility — Our team reviews your submission and confirms your license is current and valid for your state.

3. Your account is activated — You'll receive confirmation by email. You're then cleared to place orders through our website, by email, or by phone at (713) 682-3185.

Questions

Contact our team at info@dermaclip.com or call (713) 682-3185.

We're happy to walk you through the process.