Private · Application-Based

Apply For Platform Access.

Tell us about your practice — our team will review your application and reach out within 24 hours.

Verified providers only 24-hour review Dedicated account liaison

Approval is not guaranteed. Blueprint Provider Access is a private, application-based platform; all clinical and prescribing decisions remain under licensed-provider authority.

Provider Application

Complete Your Practice Profile

Complete the details below so our team can verify your practice and prepare your platform walkthrough.

Account Details

First Name *

Last Name *

Email *

Phone *

Password *

Confirm Password *

Referral Code or Referral Email (optional)

Business & Verification Details

Preferred Username *

Office / Company Name *

Business Type (optional)

Provider Role

Ordering Preferences

License Information

NPI Number *

DEA Number (optional)

Office Address

Street Address 1 *

Street Address 2 (optional)

City *

State *

ZIP *

Shipping Address

Same as office address

Business Hours

Business Hours (optional)

Verification

I verify this information is accurate.

By submitting, you confirm the information is accurate and complete.