• Optimal Balance Pharmacy Account Setup

    Thank you for partnering with Optimal Balance Pharmacy. This form collects essential account demographics, licensure, and DEA information required to verify prescriptive authority and ensure compliance with all State Boards of Pharmacy and federal regulations. Accurate and complete information helps us activate your account efficiently and prevent delays in processing prescriptions. We appreciate the opportunity to support you and the patients you serve.

  • Account Demographics

    This section collects your clinic’s physical address and practice details to properly establish your account within our system.
  • Format: (000) 000-0000.

  • Practice Model

    You will identify whether your practice operates as a physical location, telemedicine only, or a hybrid model. This information ensures accurate records, proper state licensure alignment, and compliance with applicable regulatory requirements.
  • Please indicate below how the clinic provides patient services*
  • How will your clinic send prescriptions to Optimal Balance Pharmacy?*
  • In which states do you see patients?*
  • A quick note before you continue. Prescriptions sent through an EMR often arrive without the details a compounded medication needs (the compounded product, sig, quantity, and refills), so they take an extra 1 to 2 days to process and may require a clarification call to your office. Orders placed in LifeFile, Optimal Balance's prescriber portal, come through complete and process the same day, and your team gets order status, tracking, and reporting in one place. Setup takes a few minutes and your Optimal Balance rep will walk you through it. To switch, select LifeFile prescriber portal above.
  • Would you like your Optimal Balance rep to set your clinic up on LifeFile?*

  • Contacts for Prescription Clarifications

    This section collects key information for clinic staff who will interact with Optimal Balance Pharmacy, including name, title, phone number, and email address. You will also designate the appropriate access level and privileges needed within our LifeFile Pharmacy system. Providing accurate details ensures secure system access, proper role alignment, and protection of patient information.
  • Format: (000) 000-0000.
  • Will this person require privileges to LifeFile Account*
  • If yes, please select the level of privileges
  • Would you like to add Optional Staff/Clinician to your Account*
    • Additional Contact to Add to Account  
    • Format: (000) 000-0000.
    • Will this person require privileges to LifeFile Account*
    • If yes, please select the level of privileges*
    • Billing Information 

    • Billing Information

      For Bill-Clinic accounts, please enter the card you would like on file below. Please sign to authorize Optimal Balance Pharmacy to charge this card for clinic-billed orders.
  • Is your Shipping Address for your Clinic different than from the Account Demographics section?*

  • Shipping Information

    In this section we will collect your shipping information and also collect the days of the week your clinic accepts shipments.
  • Where should orders ship?*
  • Nevada orders ship directly to the patient.
  • Which days is your clinic closed or unable to receive shipments?
  • What hours can your clinic receive shipments?*
  • Shipping Availability - Use the checkboxes below to indicate the day you can receive shipments.*

  • Prescriber Demographics

    Please provide licensure and credentialing details for every prescriber who will send prescriptions through your clinic (MD, DO, NP, PA, or other).
  • Format: (000) 000-0000.
  • Does this prescriber currently hold active prescriptive authority in their licensing state?*
  • Prescribers licensed outside Texas as an NP, APRN, or PA can order non-controlled medications through Optimal Balance Pharmacy. OBP does not accept Schedule III-V prescriptions from out-of-state NPs, APRNs, or PAs. If a physician (MD or DO) at your practice will write and sign controlled prescriptions for these patients, add them as an additional prescriber below.
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  • Electronic Prescribing of Controlled Substances (EPCS) Verification with IdenTrust

    If this prescriber will prescribe Schedule III-V controlled substances through Optimal Balance Pharmacy, please select one of the options below.

    Option 1: This prescriber has an active IdenTrust account

    Please enter this prescriber’s IdenTrust username below. Optimal Balance Pharmacy will verify their credentials and add their EPCS information to their LifeFile profile for future controlled substance prescribing.

    Option 2: This prescriber does not have an EPCS account or prefers to use a signed paper prescription

    For each Schedule III-V controlled substance prescription, please print the prescription, sign the hard copy, and fax it to Optimal Balance Pharmacy at 833-702-1164.

    Prescribers may also upload their Signed, Prescription PDF using LifeFile's Script-to-Scan feature.

    Interested in Setting up an idenTrust Account? Steps to set up an IdenTrust Account

    Please Note: Controlled substance orders will remain in Needs Clarification until the signed hard-copy prescription is received and reviewed.

  • Would you like to add additional prescribers?*
  • Additional Prescriber Demographics.
  • Does this prescriber's state require a supervising or collaborating physician to prescribe?*

  • Delegating Physician (Texas NPs, APRNs and PAs).

    Please provide the supervising physician’s demographic and licensure information, including contact details, NPI, state license, and DEA registration if applicable. This information is required to verify prescriptive authority and ensure compliance with applicable state regulations governing mid-level practitioners. Accurate and complete details will help prevent delays in account approval and prescription processing.
  • Is the delegating physician already listed as a prescriber on this form?*
  • Format: (000) 000-0000.
  • Either now or in the future will the Supervising or Collaborative Physician intend on prescribing Schedule III or Schedule IV substances such as Testosterone or Phentermine?*
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  • Electronic Prescribing of Controlled Substances (EPCS) Verification with IdenTrust

    If the physician will prescribe Schedule III-V controlled substances through Optimal Balance Pharmacy, please select one of the options below.

    Option 1: The physician has an active IdenTrust account

    Please enter the physician’s IdenTrust username below. Optimal Balance Pharmacy will verify their credentials and add their EPCS information to their LifeFile profile for future controlled substance prescribing.

    Option 2: The physician does not have an EPCS account or prefers to use a signed paper prescription

    For each Schedule III-V controlled substance prescription, please print the prescription, sign the hard copy, and fax it to Optimal Balance Pharmacy at 833-702-1164.

    Prescribers may also upload their Signed, Prescription PDF using LifeFile's Script-to-Scan feature.

    Interested in Setting up an idenTrust Account? Steps to set up an IdenTrust Account

    Please Note: Controlled substance orders will remain in Needs Clarification until the signed hard-copy prescription is received and reviewed.

  • Would you like to add Additional Supervising/Collaborative Physicians to your account?*
  • Additional Supervising/Collaborative Physician Demographics

  • Ready to Submit your Form

    Please click submit to submit your New Account Form. If you need to revisit, you can also click the save button.
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