Report of Theft or Loss of Controlled Substances (DDC-52 Form)

Information about Registrant
Please select an option to continue
Theft or Loss Details
Please select an option to continue
Have you experienced loss in transit from the same carrier in the past?
Have you reported this to the licensee's State Board?
Provide the address and telephone number of the nearest DEA office that received the report about the incident.
Provide information about the Police department that received the report about the incident.
(If your response is longer than 5000 characters, you may upload it as a document after submitting the report)
5000 chars left / 5000 character max
(If your response is longer than 5000 characters, you may upload it as a document after submitting the report)
5000 chars left / 5000 character max
List of Controlled Substances Lost or Stolen
Back