Get Obndd New Practitioner Form

The OBNDD New Practitioner Form is an essential document for individuals seeking registration with the Oklahoma Bureau of Narcotics and Dangerous Drugs. This guide will provide you with clear, step-by-step instructions to complete the form accurately and efficiently using an online approach.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your full name in the designated field labeled 'Practitioner Name.' Make sure to use your legal name as it appears on your professional license.
3. In the section for 'Physical Oklahoma Business Address', enter a complete street address, including the ZIP code. Remember, post office boxes or route numbers alone will not be accepted. If you lack a physical address, include directions to the location along with a PO Box.
4. Select whether you are a new applicant or renewing an existing application. If you are renewing, be sure to provide your 5-digit OBNDD registration number.
5. Fill in your email address, as this will be the primary method for receiving your Certificate of Registration. Ensure it is accurate to avoid any delays.
6. Input your business phone and fax numbers in the respective fields. Verify the format is correct for each number.
7. Provide your Social Security number and date of birth in the specified fields. This information is required for identification purposes.
8. Specify your professional designation by choosing one option from the list provided, such as M.D. or D.O., and enter your current Oklahoma Professional Licensing Board Number.
9. If applicable, indicate your current DEA number, and check the box if it is pending. Include the expiration date if available.
10. Address questions regarding exemptions from payment of the registration fee, along with any relevant explanations if you answered 'Yes'.
11. Respond to inquiries related to any past convictions or disciplinary actions. Attach explanation letters if needed.
12. Affix your signature in the designated field and date it accordingly. This indicates your affirmation of the information provided.
13. Once all sections are completed, review your information for accuracy. After verifying, you can save changes, download, print, or share the completed form.

Complete your OBNDD New Practitioner Form online today to ensure your registration process is smooth and efficient.