Schedule II Return Request

Simply click the submit button at the bottom of the page and your request will be processed within 24 hours. You may also print a .pdf version of the form, complete the form, and then fax to: 630-892-8780, Attention: CII Department. Back to the Forms Page

SHIPPER INFORMATION
Enter all Shipper Information as it appears on your DEA registration. Please include a Photocopy of your DEA registration.

# OF FULL PACKAGES RETURNED # OF UNITS IN PARTIAL PACKAGES ORIGINAL PACKAGE SIZE DRUG/BRANDS NAME STRENGTH NDC (National Drug Code) NUMBER










GENERAL INFORMATION
1) Complete sections 2 & 3, making sure that you PRINT CLEARLY, and provide us with all the required information.
2) After completing this form, fax it to:
630-892-8780, Attn: CII Dept.
3) This form may be copied for use.
4) It is a violation of DEA Regulations to ship CIIs before receiving a DEA 222 form.
CII PRODUCT INFORMATION
1) Only ten (10) lines are allowed per DEA Form 222.
2) Each partial bottle must be entered on a separate line.
3) Multiple full packages of the same product (name, strength, size & NDC number) may be entered on the same line.
4) All information is required, or this form will be returned to you.
Verification Image
NOTE: Please print before submitting if you'd like to retain a copy for your records.