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Please provide us your Shipping and Billing information below. This information will be used to process your order. Your registration form cannot be submitted without making a selection from the Reason for requesting restricted items field.

Complete all fields and please adhere to the following. If you are registering as an HHS agency employee,

If you are registering as a medical doctor or from a medical or healthcare provider's office, list your office or company name in the Company Name field.

After you register, you will receive a confirmation e-mail. The HHSC Pinnacle Cart administrator will have to change a setting in your account to finalize your registration process. After the change is made to your account, you will be able to view the list of forms and publications under the HHSC and DSHS categories.

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Please check this box if your shipping information is the same as billing. If it is not, you may simply add your shipping address in the future.

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