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Before You Get Started

The Brightiva Network is open to licensed prescribers with an active DEA registration. Here is what to expect when you register:

Initial enrollment fee: $169

Non-refundable and due at the time of application. Upon approval, this grants you access to the Brightiva physician portal including the proprietary treatment protocol, clinical documentation templates, dosing guidelines, and the secure ordering system.

A valid card on file is required

A credit or debit card must be provided at registration and maintained throughout your membership. It will be used to process all orders and any applicable membership fees.

Monthly order minimum

Membership requires a minimum of one patient order per month. Meeting this minimum keeps your membership active with no additional fees.

If no order is placed during a calendar month, a fee of $49 will be charged to maintain your active membership.

Cancellation and rejoining

You may cancel at any time without a fee, yet $49 will be charged for any partial calendar month without an order prior to the cancellation request.

If you cancel and then decide to rejoin at a later date, a non-refundable re-enrollment Fee of $169 is required again, even if it is in the same calendar year.

Application review

Applications are reviewed by the Brightiva team, usually within one to two business days. Login credentials are issued by email upon approval. Verification by our ePrescribe partner can take up to an additional 48 hours before orders can be placed.

Physician Information

NPI Number *
NPI Check Required to Apply
First Name *
Last Name *
Email *
Phone *
Medical Specialty *
Medical License Number *
Medical License State *
DEA Number *
DEA Registration State *

Practice Information

Clinic Location where Brightiva will be shipped *
Signature *