Controlled Substance Ordering System Homepage

This form may be used to notify DEA of potential security concerns related to the CSOS Program.
Bold fields with an asterisk ( * ) are required.

Contact information:
First Name:*
Last Name:*
E-Mail Address:*
Telephone Number:	- - Ext:
DEA Registration Number:
Organization Name:*
Organization Address:
City:
State:
Zip Code:
Security Concern:
Explanation:*	Describe your security concern. Please be as descriptive as possible.

CSOS Security Concern Form